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Submitted: 21 Mar 2017
Revision: 06 Jun 2017
Accepted: 09 Jun 2017
ePublished: 29 Jun 2017
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J Cardiovasc Thorac Res. 2017;9(2): 108-112.
doi: 10.15171/jcvtr.2017.18
PMID: 28740631
PMCID: PMC5516050
  Abstract View: 790
  PDF Download: 761

Original Article

Increased risk of coronary perforation during percutaneous intervention of myocardial bridge: What histopathology says

Somayeh Pourhoseini 1, Mohammad Bakhtiari 2, Abdolreza Babaee 1, Mohammad Ali Ostovan 3,4, Seyed Hassan Eftekhar-Vaghefi 1, Nikan Ostovan 4, Pooyan Dehghani 3,4 *

1 Department of Anatomy, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
2 Department of Anatomical Science and Molecular Biology, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
4 Shiraz Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Introduction: Myocardial bridge (MB) is a segment of a major epicardial coronary artery that goes intramurally under a bridge of overlying myocardium. Complications have been reported during or after stent implantation particularly coronary perforation. The aim of this study was to determine histological differences between proximal left anterior descending artery (LAD) and the tunneled segment that may have a possible role in increased risk of coronary artery perforation during percutaneous coronary intervention.
Methods: Twenty specimens of MB were obtained from dissection of 45 cadavers. Sections were stained using hematoxylin and eosin (H&E), and trichrome methods. The proximal section and the tunneled artery were compared with a normal sample in terms of the characteristics of a muscle artery.
Results:
The findings of this study showed an MB prevalence of 51%, as 23 out of the 45 examined cadavers were discovered to be afflicted by the MB. The intima layer in the suffering artery had gone through significant hypertrophy, while it had remained thin in the tunneled artery section. The epithelial cells under the bridge were spindle-shaped, while they were polygonal in the proximal section. In the myocardium the nuclei of the muscle fibers in the MB section were smaller than the normal section. Adventitial layer was almost normal.
Conclusion:
The histopathological differences between MB and proximal part of vessel combined with small vessel diameter in the tunneled segment can explain the high incidence of the LAD rupture and perforation in the section under the bridge.
Keywords: Myocardial Bridge, Coronary Perforation, Histopathology, Percutaneous Coronary Intervention
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