Role of Myocardial Bridging in Myocardial Ischemia: Case Report

INTRODUCTION: Myocardial bridging (MB) is considered a benign pathology, however, its existence is often associated with angina pectoris, myocardial infarction, ventricular tachycardia and sudden cardiac death. The clinical significance of MB is determined by the dynamic stenosis of the coronary artery, which depends on the rate and strength of heart contractions and is poorly visualized by instrumental methods, which impairs timely diagnosis and early administration of the adequate treatment. A clinical case of a combined damage to the coronary bed in a 58-year-old patient is presented: MB of the anterior interventricular artery (AIVA) causing dynamically significant narrowing of the tunnel artery and hemodynamically insignificant atherosclerotic lesion of the coronary arteries. MB was typically located in the mid-segment of the AIVA. The diagnosis of the anomaly of the coronary bed was established after coronary angiography: MB of AIVA led to stenosis of the tunnel segment to 80% and was the cause of angina attacks. Stenting of the AIVA with a drug-coated stent was performed. The effectiveness of the stenting can be referred to a peculiar feature of this case, since in the treatment of this pathology the preference is given to myotomy and coronary artery bypass grafting as more effective methods. The follow-up period was 7.5 years; after stenting of the tunnel segment of the AIVA the anginal attacks did not recur.

CONCLUSION: The described clinical case demonstrates the role of MB in the development of myocardial ischemia. With timely diagnosis of the coronary blood flow disorders, successful revascularization and adequate pharmacotherapy in accordance with the current clinical recommendations, the prognosis is good.