JACC. Case reports · 2026
Multimodality Assessment of a Culprit LAD Myocardial Bridge in a Patient With Congenital Heart Disease.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Singh Som, Ravipati Goutham, Mann Harnoor, Uppu Santosh, Mallula Kiran, Ramzy Danny, Gregoric Igor D, Kar Biswajit, Basra Sukhdeep Singh
Аннотация
BACKGROUND: Myocardial bridging is a congenital coronary anomaly in which a segment of an epicardial artery is tunneled within the myocardium. Although many cases remain asymptomatic, hemodynamically significant bridges may require surgical intervention.
CASE SUMMARY: A 57-year-old man with a history of an unrepaired ventricular septal defect presented with recurrent chest pain. Initial imaging identified a 4.7-cm myocardial bridge in the left anterior descending artery. Functional testing with fractional flow reserve, instantaneous wave-free ratio, and diastolic hyperemia-free ratio confirmed hemodynamic significance. Optical coherence tomography was performed to further visualize the segment. The patient underwent successful surgical unroofing, resulting in complete symptom resolution.
DISCUSSION: This case highlights a multimodal intracoronary approach incorporating intracoronary anatomical and physiological testing to determine the hemodynamic significance of myocardial bridging.
TAKE-HOME MESSAGE: Multimodal intracoronary anatomical and physiological testing is imperative for diagnosing myocardial bridges in patients presenting with undifferentiated angina, thereby influencing management.
CASE SUMMARY: A 57-year-old man with a history of an unrepaired ventricular septal defect presented with recurrent chest pain. Initial imaging identified a 4.7-cm myocardial bridge in the left anterior descending artery. Functional testing with fractional flow reserve, instantaneous wave-free ratio, and diastolic hyperemia-free ratio confirmed hemodynamic significance. Optical coherence tomography was performed to further visualize the segment. The patient underwent successful surgical unroofing, resulting in complete symptom resolution.
DISCUSSION: This case highlights a multimodal intracoronary approach incorporating intracoronary anatomical and physiological testing to determine the hemodynamic significance of myocardial bridging.
TAKE-HOME MESSAGE: Multimodal intracoronary anatomical and physiological testing is imperative for diagnosing myocardial bridges in patients presenting with undifferentiated angina, thereby influencing management.