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Stanford researcher’s sleuthing uncovers mystery of heart anomaly

heart-puzzle-stockFive years ago, Stanford cardiologist Ingela Schnittger, MD, set out to solve the mystery of a little known heart anomaly known as a myocardial bridge.

Discovered during autopsies almost 300 years ago, myocardial bridges occur when a major heart artery tunnels through the muscle of the heart rather than resting on top of the organ as it typically does. It’s long been considered benign, but no one’s really been sure.

In 2011, Schnittger began researching patients with myocardial bridges in the heart catheterization lab at Stanford. Since then, she has co-authored five research studies uncovering many of the mysteries of bridging.

In a press release on her most recent study, which was published in the Annals of Thoracic Surgery, I tell Schnittger's story, what launched her on this mission, and what she and colleagues have discovered so far. As I wrote in the release, "She wanted to know more: Could bridging be dangerous? Did it cause symptoms? How should it be treated?"

Schnittger's research has shown that compression of the heart muscle can reduce or cut off blood flow in the artery, resulting in a myriad number of serious problems including angina, myocardial ischemia and acute coronary syndrome. Most people with a bridge show no symptoms and others have mild symptoms that can be controlled with medicine. But a small group have incapacitating symptoms that medicine can’t control.

They are desperate for help, as Schnittger explains:

Many of these patients have these heartbreaking stories to tell. They can’t hold a job, they can’t travel, they can’t take care of their families. Most cardiologists are completely at a loss. They know myocardial bridges exist, but they have been taught they are benign and never cause problems.

When these patients go to the ER, and they go there a lot, all the cardiology tests come back normal. They’re told, 'Here’s a little Valium. I think you’re anxious.' They get belittled, not taken seriously, and they get really depressed.

According to this new study, a procedure called 'unroofing surgery' can safely and successfully reduce or eliminate symptoms. Unroofing surgery entails cutting through the heart muscle to uncover the tunneled artery, relieving compression on the artery caused by the bridging. Researchers had 50 patients fill out questionnaires both prior to and after undergoing unroofing surgery. Results showed the average ranking of quality of life prior to surgery by the patients was 25 percent. After surgery, that figure jumped to 78 percent.

Schnittger plans to continue researching myocardial bridges and telling patients and health care providers that this is "a real thing." As she says in the release:

Our patients come back after surgery so grateful. They have suffered for so long — finally they’ve found doctors who understand them.

 One patient, a mother of five, was so symptomatic before surgery she had arranged her whole life around her symptoms. She didn't play with her children outside; she couldn’t even pick them up at the playground. She was basically housebound. She couldn’t do laundry or go grocery shopping. After surgery, she could do all those things — laundry, play outside with her children, go for a walk. It's a life-changer.

 Our team wants to spread the word, to educate the medical community that this is a real thing.

One patient who underwent unroofing surgery at Stanford for myocardial bridging tells her story in this Stanford video.

Previously: Mystery solved: researchers use genetic tools to diagnose 3-year-olds rare heart condition and Looking at aortic valve replacement without open heart surgery
Photo by Aksabir/Shutterstock

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