SHM Converge Scientific Abstract ePoster Gallery-Extensive Myocardial Bridging Treated With Cabg

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This case report describes a 27-year-old woman with type 2 diabetes, hypertension, and hyperlipidemia who presented with epigastric pain and was later found to have symptomatic, extensive myocardial bridging of the left anterior descending (LAD) artery. During hospitalization, she developed recurrent SVT, underwent successful AVNRT ablation, and had normal systolic function on echocardiogram (EF 66%). Coronary CTA showed coronary artery disease involving the proximal LAD/diagonal branch and a long segment of myocardial bridging. Coronary angiography confirmed a long LAD bridge with physiologically significant RFR of 0.76.<br /><br />She was treated medically with beta-blockers, calcium channel blockers, and ranolazine, but continued to have daily severe chest pain. Because the bridged segment was long, the cardiothoracic surgery team felt unroofing would be inadequate and recommended off-pump CABG using LIMA to LAD/D2 and RIMA to OM1. Following surgery, her chest pain resolved.<br /><br />The report highlights that myocardial bridging is typically a benign congenital anomaly in which a coronary artery runs intramyocardially, most often the mid-LAD. Symptomatic patients are usually managed first with beta-blockers, and sometimes calcium channel blockers or other antianginals. In refractory cases, invasive options are considered. Stenting has been proposed but is limited by high restenosis rates and is generally not favored. Surgical treatment with unroofing or CABG is considered safe and effective, particularly in extensive or complex bridges where unroofing may not be feasible.<br /><br />Overall, this case supports CABG as an effective treatment for extensive, medically refractory myocardial bridging with significant ischemia and persistent angina.

Asset Subtitle

Jerry Fan

Meta Tag

Author List Billy Jones, Jerry Fan

Category Clinical Vignettes

Concept Myocardial Bridge

Concept Left Anterior Descending Coronary Artery

Concept Beta Blockers

Concept Coronary Artery Bypass Grafting

Concept Calcium Channel Blockers

Distinguished Non-Finalist

Presenter Organization Baylor Scott and White - Temple

Presenting Author Jerry Fan

Track Adult

Keywords

myocardial bridging

left anterior descending artery

coronary artery disease

angina

coronary artery bypass grafting

beta-blockers

calcium channel blockers

ranolazine

AVNRT ablation

coronary angiography

Myocardial Bridge

Left Anterior Descending Coronary Artery

Beta Blockers

Coronary Artery Bypass Grafting

Calcium Channel Blockers