MYOCARDIAL BRIDGE AS A CAUSE OF CHRONIC CORONARY ARTERY DISEASE: A CLINICAL CASE

Abstract

A myocardial bridge (MB) is a congenital anomaly in which a coronary artery passes within the myocardium. Despite its frequently benign course, under certain conditions, MB may cause severe myocardial ischemia, particularly in young patients without classical risk factors for atherosclerosis. This article presents a clinical observation of a 40-year-old patient who complained of pressing retrosternal pain during physical exertion. Multislice computed tomography coronary angiography (MSCT-CAG), an exercise stress test, and selective coronary angiography (CAG) were used for diagnosis. MSCT-CAG revealed stenosis of the left anterior descending artery (LAD) of up to 75-80%. Selective CAG diagnosed occlusion of the proximal third of the LAD; the distal vessel bed was filled via collaterals. Percutaneous coronary intervention (PCI) was performed with recanalization of the occlusion and stenting of the LAD. After successful recanalization and stenting of the occluded segment, a myocardial bridge with systolic narrowing of up to 40% was visualized in the middle third of the LAD. Thus, the MB, which had not been detected initially, was recognized as a key factor in the development of the proximal lesion and subsequent arterial occlusion. Positive clinical dynamics were achieved after the intervention. The described case demonstrates that MB may be the main cause of coronary artery disease (CAD) and coronary artery occlusion in young patients. Selective CAG is of decisive importance for verifying the diagnosis. Timely myocardial revascularization and adequate pharmacotherapy enable a favorable outcome. Keywords: Myocardial bridge, ischemic heart disease, coronary angiography, occlusion, left anterior descending artery, clinical observation.