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Published on: April 25, 2014
Surgical unroofing of hemodynamically significant myocardial bridges in a pediatric population
Katsuhide Maeda1, Ingela Schnittger2, Daniel J Murphy2
1Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
Insights
Surgical unroofing of myocardial bridges (MBs) in pediatric patients is safe and effective. This procedure relieved refractory anginal symptoms in most patients, improving their quality of life.
Area of Science:
- Cardiology
- Pediatric Surgery
Background:
- Myocardial bridges (MBs) are often incidental findings, but symptomatic cases in adults can benefit from surgical unroofing.
- Limited data exists on the efficacy of unroofing for MBs in the pediatric population.
Purpose of the Study:
- To evaluate the indications and outcomes of surgical unroofing for myocardial bridges in pediatric patients.
- To assess the safety and effectiveness of unroofing in this demographic.
Main Methods:
- Retrospective review of pediatric patients who underwent surgical relief for MBs between 2012 and 2016.
- Evaluation of clinical characteristics, diagnostic data, intraoperative findings, and postoperative outcomes.
Main Results:
- 14 pediatric patients underwent unroofing of left anterior descending artery MBs.
- 13 symptomatic patients experienced symptom resolution post-surgery, with improved quality of life.
- Unroofing was performed both with and without cardiopulmonary bypass (CPB) without complications.
Conclusions:
- Surgical unroofing of MBs is a safe procedure in pediatric patients, applicable with or without CPB.
- Unroofing effectively relieves refractory symptoms in symptomatic pediatric patients with MBs.
Background:
Although myocardial bridges (MBs) are traditionally regarded as incidental findings, it has been reported that adult patients with symptomatic MBs refractory to medical therapy benefit from unroofing. However, there is limited literature in the pediatric population. The aim of our study was to evaluate the indications and outcomes for unroofing in pediatric patients.
Methods:
We retrospectively reviewed all pediatric patients with MB in our institution who underwent surgical relief. Clinical characteristics, relevant diagnostic data, intraoperative findings, and postoperative outcomes were evaluated.
Results:
Between 2012 and 2016, 14 pediatric patients underwent surgical unroofing of left anterior descending artery MBs. Thirteen patients had anginal symptoms refractory to medical therapy, and 1 patient was asymptomatic until experiencing aborted sudden cardiac arrest during exercise. Thirteen patients underwent exercise stress echocardiography, all of which showed mid-septal dys-synergy. Coronary computed tomography imaging confirmed the presence of MBs in all patients. Intravascular ultrasound imaging confirmed the length of MBs: 28.2 ± 16.3 mm, halo thickness: 0.59 ± 0.24 mm, and compression of left anterior descending artery at resting heart rate: 33.0 ± 11.6%. Invasive hemodynamic assessment with dobutamine confirmed the physiologic significance of the MBs with diastolic fractional flow reserve: 0.59 ± 0.13. Unroofing was performed with the patient under cardiopulmonary bypass (CPB) in the initial 9 cases and without CPB in the subsequent 5 cases. All patients were discharged without complications. The 13 symptomatic patients reported resolution of symptoms on follow-up, and improvement in symptoms and quality of life was documented using the Seattle Angina Questionnaire version 7.
Conclusions:
Unroofing of MBs can be safely performed in pediatric patients, with or without use of CPB. In symptomatic patients, unroofing can provide relief of symptoms refractory to medical therapy.
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