MUSCLE BRIDGE. CLINICAL SIGNIFICANCE, DIAGNOSIS AND MANAGEMENT
Abstract
The muscular bridge (MB) is a congenital anomaly of the coronary arteries, usually benign, however, there are patients in whom the presence of myocardial bridges leads to myocardial ischemia and the development of clinical symptoms of acute coronary syndrome. The frequency of occurrence of muscle bridges in the population leaves from 5 to 40%, depending on the diagnostic method, it is more often diagnosed in men, and a predominant lesion of the anterior interventricular artery is described. To diagnose symptomatic MB, a combination of both invasive and non-invasive research methods is used, this is necessary due to the fact that clinical manifestations develop as a result of a combination of many factors (anatomical, pathophysiological, behavioral) and require a comprehensive assessment. The “gold standard” for the diagnosis of muscle bridges is coronary CT-angiography. Treatment of muscle bridges is primarily aimed at relieving symptoms, reducing myocardial ischemia and preventing adverse outcomes. The option of choice, in case of symptoms, is drug therapy, only if the therapy is ineffective, surgical treatment methods (stenting, myotomy, coronary artery bypass grafting) can be used due to the high risk of recurrence of symptoms. The lack of generally accepted recommendations obviously makes it necessary to conduct further research in the field of the problem under consideration in order to develop unified algorithms for the diagnosis and treatment of patients with muscle bridges.
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