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.
The patient was started on a β-blocker with subsequent resolution of her chest pain and underwent a successful colectomy without suffering a cardiac event.
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.
- Copyright © 1998 by American Heart Association