Myocardial bridges in children: diagnostic methods and therapeutic approaches (literature review)

Introduction. Myocardial bridges (MBs) are a congenital anomaly of the coronary arteries (CAs) in which a vascular segment runs intramurally. The widespread implementation of multislice computed tomography angiography (MSCT-CAG) has led to an increase in the detection of MBs in pediatric practice; however, the absence of uniform diagnostic criteria and management protocols creates clinical uncertainty.

Aim: To systematize current data on the prevalence, pathophysiology, clinical significance, diagnosis, and treatment of myocardial bridges in children.

Methods. A literature review was conducted using PubMed and eLibrary databases for the period 1997–2025 with keywords: myocardial bridging, children, coronary arteries, myocardial ischemia, MSCT coronary angiography.

Results. The prevalence of MBs varies from 0.5–16% with coronary angiography to 22.5–35% with MSCT. The most common localization is the left anterior descending artery and its diagonal branches. The pathophysiological basis of ischemia is dynamic systolic compression, exacerbated by tachycardia. Clinical manifestations range from asymptomatic progression to life-threatening arrhythmias and sudden death. The diagnostic algorithm includes anatomical imaging (MSCT-CAG) and functional assessment (stress tests, intravascular ultrasound (IVUS)). First-line therapy consists of β-blockers; surgical myotomy is indicated in refractory cases.

Conclusion. MBs in children require a differentiated approach that includes anatomical imaging followed by functional assessment. Risk stratification strategies and evidence-based clinical guidelines derived from prospective studies in the pediatric population are needed.

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