Myocardial Bridge: Friend, Enemy, or Frenemy?

First mentioned in 1737 by Reyman as an autopsy finding, described in 1922 by Crainicianu, named by Polacek in 1956, and angiographically shown by Portmann and Iwig in 1960, myocardial bridging encompasses the tunneled portion of a coronary artery, while the muscle band enveloping it is termed the myocardial bridge (MB). A myocardial bridge may remain silent lifelong or cause a myriad of clinical symptoms – from angina and ischemia, via syncope with arrhythmia ^, and heart failure up to sudden death ^, – however, not even children are spared irrelevant of the setting of the hypertrophic cardiomyopathy (HCMP). ^,

From the mainly pathoanatomical standpoint, three main questions remain unanswered: (1) do ethnic differences render some corners of the world more susceptible to being born with this congenital coronary artery anomaly? (2) what are the implications of single or multiple MBs of single or multiple vessels even in the absence of HCMP? Furthermore, (3) what is the real atherosclerotic burden of the tunneled and peri-bridged segment?

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