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(Circulation. 2003;107:1944.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Focal Coronary Atherosclerosis Proximal to Myocardial Bridging

Heribert Schunkert, MD

From the Clinic for Internal Medicine II, University of Luebeck, Lübeck, Germany.

Correspondence to Prof Dr med Heribert Schunkert, Clinic for Internal Medicine II, University of Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. E-mail Heribert.schunkert@innere2.uni-luebeck.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 61-year-old man presented for evaluation of retrosternal chest pain. Coronary angiography displayed an eccentric stenosis of the proximal left anterior descending coronary artery (LAD; Figure 1). Otherwise, the coronary vasculature revealed only minimal irregularities.

View larger version (88K): [in this window] [in a new window]   Figure 1. A, The right coronary artery reveals no evidence of atherosclerosis. B, The left coronary artery displays a tight, proximal stenosis in the LAD (bold arrow) proximal to the myocardial bridging (thin arrow).

The LAD was successfully revascularized by primary implantation of a 3.5x12 mm stent. The post-interventional angiogram revealed no residual stenosis. Interestingly, exten- sive myocardial bridging involving the mid-LAD as well as a prominent first diagonal branch was observed distal to the lesion (Figure 2, Movie).

View larger version (83K): [in this window] [in a new window]   Figure 2. Angiography of the left coronary artery after stent implantation in the proximal LAD (bold arrow). Prominent myocardial bridging is visible in the mid-LAD and the diagonal branch as illustrated by images in end-systole (A) and end-diastole (B).

This case is remarkable because it exemplifies focal coronary atherosclerosis proximal to myocardial bridging. This phenomenon presumably results from turbulent blood flow and elevated wall stress at vessel sites proximal to myocardial bridging.

The Movie is available as an online-only data supplement at http://www.circulationaha.org.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to . . . [Full Text of this Article]