A 52-year-old man with no history of cardiac disease was admitted to the coronary care unit because of an acute anterior wall myocardial infarction. Coronary angiography revealed single-vessel disease of the left anterior descending artery. An occluding thrombus was found distal from a bridging midsegment (Figure 1A and 1B, arrows and arrowheads, and Movie). TIMI III flow was restored after primary percutaneous intervention. Besides the bridging segment, no additional residual stenosis was found. There was only minimal myocardial damage, and the patient made an uneventful recovery.
For follow-up purposes, coronary magnetic resonance angiography was done with mid-diastolic and systolic imaging. The large bridging segment almost “disappears” during systolic imaging (Figure 2A and 2B). Despite treatment with aspirin, a β-blocker, and a calcium antagonist, he still had short-lasting episodes of chest pain. Because of an excellent prognosis in general and limited symptoms, we preferred to follow this patient conservatively.
Myocardial bridging has predominantly been an angiographic diagnosis, but newer noninvasive techniques such as electron-beam computer tomography and magnetic resonance coronary angiography are promising. The clinical relevance, however, still has to be elucidated.
The online-only Data Supplement can be found at http://circ.ahajournals.org/cgi/content/full/113/9/e390/DC1.