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Myotomy for myocardial bridge utilizing harmonic scalpel
Bryan A Miles1, Joseph A Lahorra1
1Department of Cardiothoracic Surgery, Cleveland Clinic Akron General, Akron, USA.
Insights
Myocardial bridge, a condition where coronary arteries run through heart muscle, can cause severe chest pain. Surgical myotomy using a harmonic scalpel offers a safe and effective treatment, relieving symptoms and improving operative outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Myocardial bridge involves epicardial coronary arteries passing through the myocardium, potentially causing angina.
- While often asymptomatic, myocardial bridges can lead to severe chest pain, necessitating intervention when medical management fails.
Observation:
- A 50-year-old male patient with a myocardial bridge refractory to medical treatment was successfully managed.
- The patient underwent myotomy using a harmonic scalpel, experiencing complete relief from exertional chest pain.
Findings:
- Harmonic scalpel myotomy provides superior hemostasis and protects the left anterior descending artery and heart cavity.
- This technique offers improved operative efficiency compared to traditional sharp or electrocautery methods.
Implications:
- Harmonic scalpel myotomy presents significant intra-operative advantages for myocardial bridge treatment.
- Further long-term studies are needed to compare the efficacy of different myotomy techniques.
Introduction:
Myocardial bridge is defined as epicardial coronary arteries that course through the myocardium. While frequently asymptomatic, it can present on a spectrum from stable to life threatening angina. Medical management is often successful, but failure requires stenting or bypass, both of which are inferior to myotomy in appropriate surgical candidates, the former due to morbidity and the later theoretically due to competitive flow.
Presentation Of Case:
We present an otherwise healthy 50 year old gentleman with myocardial bridge refractory to medical management who was effectively managed via myotomy performed with the harmonic scalpel, enjoying complete relief of previous exertional chest pain.
Discussion:
Historically, myotomy has been described sharply and with electrocautery. Compared to the harmonic scalpel, these techniques risk poor hemostasis and damage to the underlying left anterior descending artery, not to mention their inefficiency in terms of operative speed.
Conclusion:
In appropriately diagnosed patients, who are also suitable surgical candidates, myotomy, specifically with the harmonic scalpel, has short-term, intra-operative benefits of better hemostasis, protection of underlying left anterior descending artery and heart cavity, and improved operative efficiency. Given the lack of long-term symptomatic data on different myotomy techniques it is difficult to make comparisons of this nature.
