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(Circulation. 1998;98:821.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Myocardial Bridging

William J. Lauer, MD; ; Thomas A. Carlson, MD

From the Department of Cardiology/MMCC, Wilford Hall Medical Center, Lackland AFB, Tex (W.J.L.) and the Department of Cardiology/MCHE-MDC, Brooke Army Medical Center, Fort Sam Houston, Tex (T.A.C.).

Correspondence to William J. Lauer, MD, Major, USAF, MC, Department of Cardiology, 375th Medical Group, 310 W. Losey St, Scott AFB, IL 62225-5252.

An 84-year-old woman with exertional chest pain underwent a preoperative evaluation for a colectomy. Echocardiography revealed hyperdynamic left ventricular systolic function and moderate concentric left ventricular hypertrophy. Adenosine ²⁰¹Tl single photon emission CT (SPECT) imaging demonstrated a reversible anterior wall perfusion defect. At coronary arteriography, her coronary arteries appeared to be free of atherosclerotic disease; however, systolic bridging of the mid left anterior descending coronary artery (LAD) was observed.

Figures 1 and 2 from her coronary arteriogram demonstrate myocardial bridging. In Figure 1, systolic compression of the midportion of the LAD is seen, with return to a normal caliber during diastole seen in Figure 2. Figure 3 shows the ²⁰¹Tl SPECT images. On these verticle long-axis images, a partial perfusion defect of the anterior wall is noted with adenosine stress that reverses almost completely with rest.

View larger version (131K): [in this window] [in a new window]   Figure 1.

View larger version (136K): [in this window] [in a new window]   Figure 2.

View larger version (97K): [in this window] [in a new window]   Figure 3.

The patient was started on a ß-blocker with subsequent resolution of her chest pain and underwent a successful colectomy without suffering a cardiac event.

Footnotes

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 Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.

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				S. H. Elson, W. J. Lauer, and T. A. Carlson Myocardial Bridging • Response Circulation, June 29, 1999; 99 (25): 3323 - 3326. [Full Text] [PDF]