MYOCARDIAL BARS AND BRIDGES AND SUDDEN-DEATH

A congenital variant of the anatomical arrangement of the coronary art eries, that can be observed both angiographically and at autopsy, is t he embedding of these vessels within a tunnel of the subepicardial myo cardium. Both clinical and pathological claims and counterclaims have been made as to the functional consequences of this variation, the imp lication being that the contraction of the peri-vascular myocardium pa rticularly at accentuated heart rates would cause occlusion of the blo od flow within these arteries. The consensus is that this variant is o nly of significance when it occurs around a significant portion of a d ominant left main coronary artery in which instances it may be the cau se of sudden death during the course of strenuous exercise.