Scintographic evidence of severe myocardial hypoperfusion in a patient with left anterior descending coronary artery bridging--case report and review of the literature.
Myocardial bridging is a congenital abnormality characterized by an intramyocardial course of a major epicardial coronary artery segment. Generally considered a benign condition, myocardial bridging has been associated with angina, acute myocardial infarction, and sudden death. Herein, we report a patient with an intramyocardial segment in the mid portion of the left anterior descending coronary artery with marked systolic compression. Single photon emission computed tomography with technetium-99m tetrofosmin done to evaluate an episode of chest pain showed a large predominantly fixed perfusion defect in the mid to apical anterior wall with partial reversibility. The patient's chest pain did not recur and repeat single photon emission computed tomography imaging 14 days later with rest-redistribution thallium-201 showed normal myocardial perfusion. The overall clinical impression was that myocardial bridging resulted in severe transient anterior myocardial hypoperfusion. The literature on prevalence, diagnosis, use of perfusion imaging, and hemodynamic effects of myocardial bridging is reviewed.
Zurick
Andrew O
AO
Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina 27599, USA. azurick@unch.unc.edu
Klein
J Larry
JL
Stouffer
George A
GA
D000241:Adenosine / Q000737:chemistry; D003326:Coronary Circulation; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D054084:Myocardial Bridging / Q000000981:diagnostic imaging* / Q000473:pathology; D009206:Myocardium / Q000378:metabolism*; D009943:Organophosphorus Compounds / Q000737:chemistry / Q000378:metabolism; D015609:Organotechnetium Compounds / Q000737:chemistry / Q000378:metabolism; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes / Q000378:metabolism
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; C078700:technetium tc-99m tetrofosmin; D000241:Adenosine