1. Update on Myocardial Bridging
by Stefan Möhlenkamp, Waldemar Hort, Junbo Ge, and Raimund Erbel
Circulation
Volume 106(20):
November 12, 2002
Copyright © American Heart Association, Inc. All rights reserved.

2. Figure 1. Typical systolic compression (arrows) of the mid LAD at two sites in series.
Figure 1. Typical systolic compression (arrows) of the mid LAD at two sites in series. Diastolic lumen dimensions are normal. The coronary tree shows no angiographic signs of coronary atherosclerosis.
Stefan Möhlenkamp et al. Circulation. 2002;106:
Copyright © American Heart Association, Inc. All rights reserved.

3. Figure 2. Myocardial bridge of the LAD in consecutive 1 cm thick left ventricular slices with the use of post mortem coronary angiography.
Figure 2. Myocardial bridge of the LAD in consecutive 1 cm thick left ventricular slices with the use of post mortem coronary angiography. (1) The tunneled segment runs in the interventricular sulcus, giving off a large septal branch, (2) dives into the septal myocardium approaching the right ventricular chamber, (3) passes along the right ventricular endocardium, and (4) returns to the interventricular sulcus. Reprinted from Figure 3.8 of reference 36 with permission from Springer-Verlag GmbH & Co. Copyright 2000 Springer-Verlag GmbH & Co.
Stefan Möhlenkamp et al. Circulation. 2002;106:
Copyright © American Heart Association, Inc. All rights reserved.

4. Figure 3. Histologic cross section showing (a) a tunneled segment and (b) an epicardial branch of the LAD. The epicardial segment shows intima thickening as a sign of early atherosclerosis but the tunneled segment does not.
Figure 3. Histologic cross section showing (a) a tunneled segment and (b) an epicardial branch of the LAD. The epicardial segment shows intima thickening as a sign of early atherosclerosis but the tunneled segment does not.
Stefan Möhlenkamp et al. Circulation. 2002;106:
Copyright © American Heart Association, Inc. All rights reserved.

5. Figure 4. Pathological specimen showing an opened coronary artery with a thin myocardial bridge (arrows) and adjacent proximal and distal epicardial segments.
Figure 4. Pathological specimen showing an opened coronary artery with a thin myocardial bridge (arrows) and adjacent proximal and distal epicardial segments. The proximal segment shows fatty lesions, whereas the tunneled segment is spared from atherosclerosis.
Stefan Möhlenkamp et al. Circulation. 2002;106:
Copyright © American Heart Association, Inc. All rights reserved.

6. Figure 5. IVUS-images of the myocardial bridge during diastole (left) and systole (right).
Figure 5. IVUS-images of the myocardial bridge during diastole (left) and systole (right). A “half-moon”–like area surrounding the tunneled segment is present during the entire cardiac cycle. Reprinted from reference 42 with permission from Elsevier Science.
Stefan Möhlenkamp et al. Circulation. 2002;106:
Copyright © American Heart Association, Inc. All rights reserved.

7. Figure 6. ICD-images of the myocardial bridge showing retrograde flow during systole (double arrows) in the proximal segment of the bridge after nitroglycerin provocation.
Figure 6. ICD-images of the myocardial bridge showing retrograde flow during systole (double arrows) in the proximal segment of the bridge after nitroglycerin provocation. A typical “fingertip” phenomenon can be visualized in diastole (single arrow). Scale in cm · s−1. Reprinted from reference 42 with permission from Elsevier Science.
Stefan Möhlenkamp et al. Circulation. 2002;106:
Copyright © American Heart Association, Inc. All rights reserved.

8. Figure 7. Noninvasive electron beam CT coronary angiography depicting a brief tunneled segment in mid LAD in a patient with no coronary calcification and angiographically normal coronary arteries.
Figure 7. Noninvasive electron beam CT coronary angiography depicting a brief tunneled segment in mid LAD in a patient with no coronary calcification and angiographically normal coronary arteries.
Stefan Möhlenkamp et al. Circulation. 2002;106:
Copyright © American Heart Association, Inc. All rights reserved.