Myocardial Bridge as a Cause of Exertional Chest Pain
Intramyocardial tunneling of a coronary artery can mimic myocardial
ischemia, where the LAD is positioned intramuscular, different to the
normal epicardial positioning of the coronary arteries. It is more
frequent in females, and it is a benign finding. However, when
symptomatic, myocardial bridging produces a decrease in the blood flow
to the myocardium, when the vessel gets compressed during systole.
patients with angina received a regular workup, including an
echocardiogram. They are then started on medical management. However, if
it doesn’t work, additional imaging is required to prove the presence
of a myocardial bridge and these patients are referred for a surgical
After a median sternotomy, the heart
was arrested. The distal LAD was identified distally and was dissected
out of the myocardium. Using self-retaining retractors, the authors were
able to trace the intramyocardial LAD back to the first diagonal where
the LAD was in its normal epicardial anatomic position. After
dissection, and to prevent scarring over the LAD again and promote
patency, myocardial edges were imbricated with a 4-0 running prolene.
Finally, the authors reanimated the heart and came off bypass without
- Boyd JH, Pargaonkar VS, Scoville DH, Rogers IS, Kimura T, Tanaka S, et al. Surgical unroofing of hemodynamically significant left anterior descending myocardial bridges. Ann Thorac Surg. 2017;103(5):1443-1450.
- 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. eCollection 2019.