Myocardial bridging is a common coronary abnormality often associated with
left ventricular hypertrophy. It can be noted incidentally on coronary angiography by findings of systolic narrowing of the involved coronary artery. We present the case of a 59-year-old woman that presented with a
non-ST elevation myocardial infarction. She had a history of angina and workup 9-months prior with CT coronary angiography that revealed an intra-myocardial course of the left anterior descending coronary artery (LAD) with minimal
stenosis and no concomitant
coronary artery disease. Invasive coronary angiography now demonstrated apparent
myocardial bridging associated with a severe fixed
stenosis of the LAD without change in diameter with
nitroglycerin injection. Due to persistent symptoms, surgical
myotomy was attempted and then aborted because of difficulty unroofing the LAD due to surrounding
fibrosis.
Coronary artery bypass grafting (CABG) was then successfully performed using a left internal mammary artery graft. The patient had complete resolution of her
chest pain and was without functional limitation at 3-month follow-up. This case highlights possible sequelae of
myocardial bridging and suggests that, in rare cases, fixed obstruction of the involved coronary artery may occur in the setting of
fibrosis of the bridged segment. In such cases, surgical
myotomy may not be feasible and CABG may be required.