title: Surgical Unroofing of Hemodynamically Significant Left Anterior Descending Myocardial Bridges.
abstract: BACKGROUND
  Left anterior descending artery myocardial bridges (MBs) range from clinically insignificant incidental angiographic findings to a potential cause of sudden cardiac death. Within this spectrum, a group of patients with isolated, symptomatic, and hemodynamically significant MBs despite maximally tolerated medical therapy exist for whom the optimal treatment is controversial. We evaluated supraarterial myotomy, or surgical unroofing, of the left anterior descending MBs as an isolated procedure in these patients.
  
  
  METHODS
  In 50 adult patients, we prospectively evaluated baseline clinical characteristics, risk factors, and medications for coronary artery disease, relevant diagnostic data (stress echocardiography, computed tomography angiography, stress coronary angiogram with dobutamine challenge for measurement of diastolic fractional flow reserve, and intravascular ultrasonography), and anginal symptoms using the Seattle Angina Questionnaire. These patients then underwent surgical unroofing of their left anterior descending artery MBs followed by readministration of the Seattle Angina Questionnaire at 6.6-month (range, 2 to 13) follow-up after surgery.
  
  
  RESULTS
  Dramatic improvements were noted in physical limitation due to angina (52.0 versus 87.1, p < 0.001), anginal stability (29.6 versus 66.4, p < 0.001), anginal frequency (52.1 versus 84.7, p < 0.001), treatment satisfaction (76.1 versus 93.9, p < 0.001), and quality of life (25.0 versus 78.9, p < 0.001), all five dimensions of the Seattle Angina Questionnaire. There were no major complications or deaths.
  
  
  CONCLUSIONS
  Surgical unroofing of carefully selected patients with MBs can be performed safely as an independent procedure with significant improvement in symptoms postoperatively. It is the optimal treatment for isolated, symptomatic, and hemodynamically significant MBs resistant to maximally tolerated medical therapy.
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California. Electronic address: jackboyd@stanford.edu.
authors.forename: Jack H
authors.initials: JH
authors.lastname: Boyd
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Vedant S
authors.initials: VS
authors.lastname: Pargaonkar
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: David H
authors.initials: DH
authors.lastname: Scoville
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Rogers
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Takumi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Shigemitsu
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Yamada
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Fischbein
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Tremmel
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: Robert Scott
authors.initials: RS
authors.lastname: Mitchell
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Ingela
authors.initials: I
authors.lastname: Schnittger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D025401:Echocardiography, Stress; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D054084:Myocardial Bridging / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D011446:Prospective Studies; D055815:Young Adult