Myotomy for Severe Left Anterior Descending Myocardial Bridging: A Case Report
Abstract
Background: Myocardial Bridging (MB) is defined as a segment of a coronary artery that courses within the myocardium, which may result in systolic compression of the tunneled segment and compromise coronary blood flow. The Left Anterior Descending (LAD) artery is the most commonly affected vessel, with a reported incidence of 70-97%. This case report describes the incidental identification of MB in a patient scheduled for cardiac surgery and outlines the subsequent surgical management.
Case illustration: A 53-year-old male was referred to our center with severe Mitral Regurgitation (MR). He had recurrent hospitalizations for symptoms of heart failure without any complaint of angina. Echocardiography revealed preserved Left Ventricular (LV) ejection fraction and severe MR. A positive ischemic response was observed on treadmill stress testing. Preoperative Coronary Angiography (CAG) demonstrated severe MB in the distal LAD, without evidence of coronary plaque. The patient underwent Mitral Valve (MV) repair with concomitant myotomy, resulting in improved LAD-MB without residual compression. Postoperative CAG confirmed complete resolution of the MB, with no evidence of a milking effect.
Conclusion: The management of MB remains challenging, and treatment strategies should be tailored to individual patient characteristics. Surgical myotomy is a viable treatment option, as demonstrated by the favorable outcome in this case.
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