Left Circumflex Coronary Artery Bridging.

Abstract

SUMMARYMyocardial bridging most frequently occurs on the left anterior descending coronary artery and may cause ischemia and related complications. Right coronary artery myocardial bridges (MB) are rare. We report a patient with an unusual coronary bridge, a left circumflex coronary artery bridge, who presented with exercise-induced angina pectoris that was relieved with medical therapy. (Jpn Heart J 2002; 43: 423-427) Key words: Myocardial bridging, Left circumflex coronary artery, Ischemia, Betablocker therapy MYOCARDIAL bridge (MB) is defined as the intramural course of a major epicardial coronary artery, 1) and mostly is confined to the left ventricle and the left anterior descending coronary artery. Several right coronary MBs have been reported, 2-5) but only two left circumflex MBs have been reported in the literature. 6,7) In this article, we present a case of left circumflex MB and discuss the unusual locations of MB, mechanism of ischemia, and therapeutic approaches. CASEA 45-year-old hypertensive Turkish male was admitted to hospital because of chest pain radiating to the left shoulder on exertion for the last 4 months. Chest pain episodes were almost always induced with exercise and rapidly disappeared with resting. He had no risk factors for coronary artery disease except smoking and family history. Blood tests, including CBC, electrolytes, liver enzymes and lipid profile, were in their normal ranges. Physical examination was unremarkable. Blood pressure was slightly high (150/95 mmHg). The resting ECG was normal but after 7 minutes of exercise with the Bruce protocol he developed chest pain associated with 1.5 mm horizontal ST depression in the inferior and lateral leads. Coronary angiography showed normal left main and normal left anterior descending and right coronary arteries. The left circumflex artery was also norFrom the

A rare case of myocardial bridge involving left anterior descending, obtuse marginal and ramus intermediate coronary arteries

“…[2] reported that out of 61 patients with a myocardial bridge, only one had an additional myocardial bridge of the posterior descending branch of the right coronary artery. In the literature, there are few reported cases of a myocardial bridge in the left circumflex coronary artery [3]. One of these reported patients had myocardial infarction treated by stenting of the bridged segment [4].…”

Myocardial bridges of the coronary arteries in the human fetal heart

“…Myocardial bridges are one of the non-atherosclerotic anatomical abnormalities of the coronary arteries (Okmen et al 2002) . It has been suggested that the number, extent and the location of the myocardial bridges may have clinical significance (Bezerra et al 1987).…”

Myocardial bridges: A review

“…The wide variation in frequency shows that many bridges do not produce symptoms during life and thus, the individuals with the bridges are not subjected to diagnostic arteriography (De Winter et al,1998). Moreover, arteriography is more likely to identify deep versus superficial bridging (Ferreira et al,1991; Okmen et al,2002). In association with other clinical conditions, the prevalence of myocardial bridges in children with hypertrophic cardiomyopathy has been found to be greater than in the general population and has been identified in up to 25% of these patients (Reig et al,1990; Yetman et al,1998; Gow,2002).…”