Mok S, Majdalany D, Pettersson GB. Extensive unroofing of myocardial bridge: A case report and literature review.
SAGE Open Med Case Rep 2019;
7:2050313X18823380. [PMID:
30719302 PMCID:
PMC6349980 DOI:
10.1177/2050313x18823380]
[Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 12/13/2018] [Indexed: 01/29/2023] Open
Abstract
Background:
Myocardial bridge is defined as a segment of a coronary artery that takes an
intramyocardial course. The presence of myocardial bridge has been observed
in as many as 40%–80% of cases on autopsy, angiographically from 0.5% to
16.0%, and often asymptomatic. However, it has been associated with angina,
coronary spasm, myocardial infarction, arrhythmias, syncope, sudden cardiac
arrest, and death. Conflicting opinions exist on the timing of surgical
intervention for myocardial bridge.
Methods:
We present an unusual case of a young female, with prior aortic surgery, who
had refractory chest pain despite optimal medical therapy. Stress testing
revealed anterior ischemia. Cardiac catherization showed myocardial bridge
of the left anterior descending artery with significant compromise of blood
flow (fractional flow reserve = 0.75 with adenosine). We proceeded with
surgery. Intraoperatively, we found an unusually long (10-cm)
intramyocardial segment of the left anterior descending artery which was
managed by surgically unroofing. Our patient felt better post procedure.
Repeat cardiac catheterization showed no further narrowing of the left
anterior descending artery with a fractional flow reserve of 0.87 in its
distal segment.
Results/discussion:
Myocardial bridge is present mostly in female patients (74.5%), with median
age at 56.2 years and mostly involving the left anterior descending artery
(77.2%). The average length of myocardial bridge is 21.85 ± 16.10 mm (range:
5–70 mm). Our case is unique as the involved myocardial bridge was 10 cm in
length, the longest ever reported. Multiple imaging modality revealed
significant coronary insufficiency, with a subsequent clinical and
angiographic improvement upon unroofing of the culprit coronary vessel.
Conclusion:
Management decision on myocardial bridge remains controversial. This is a
case of the longest symptomatic myocardial bridge, with a subsequent
improvement post unroofing.
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