Myocardial Bridging in an Adult Patient with d-Transposition of the Great Arteries

Abstract

Myocardial bridging is characterized by intra-myocardial course of a segment of an epicardial coronary artery, leading to systolic compression. In most cases, it is considered a benign condition but rarely has been associated with serious cardiac events like myocardial infarction and sudden death. We describe a 25-year-old man with known d-transposition of the great arteries (d-TGA) status post-Mustard procedure who presented with palpitations and chest pain. Cardiac catheterization revealed complete systolic compression of a myocardial bridging segment of the left anterior descending artery and also complete compression of the first septal perforator during episodes of ectopic atrial tachycardia. No percutaneous or surgical interventions were performed. Symptoms improved after cautious use of beta-blockers. This appears to be the first report of symptomatic myocardial bridging in an adult patient with d-TGA.

Multiple myocardial bridges causing severe ischaemia in adolescent with pulmonary stenosis

“…2,8 Myocardial bridging in association with structural CHD has been reported only in a neonate with coarctation, ventricular septal defect, and parachute mitral valve 2 and an adult with transposition of the great arteries after Mustard procedure. 3 Our case and these two reports prove that myocardial bridges can exist in patients with CHD and may account for their symptomatology. This fact is important as symptoms of myocardial bridges may be mistakenly attributed to residual CHD thus delaying diagnosis and, also, because young patients with significant structural heart disease and dysfunction may be more susceptible to life-threatening complications of myocardial bridges, such as arrhythmias and sudden death.…”

“…1 They almost exclusively affect the left anterior descending coronary artery and have rarely been reported in children 2 or in association with CHD. 2,3 Ischaemia related to myocardial bridges may be due to direct compression during cardiac systole as well as endothelial injury of the vessel proximal to the myocardial bridge due to abnormal haemodynamics resulting in coronary atherosclerosis and stenosis. 1 The latter is probably the reason that myocardial bridges often become symptomatic later in life despite their presence since birth.…”

“…Myocardial bridges are usually visualised with invasive coronary angiography showing the milking or squeezing of the affected coronary artery, but can also be depicted and possibly quantified using intracoronary ultrasound, MRI, and CT. 3 Multidetector CT offers increased detection rates of myocardial bridging due to its higher resolution as well as the direct depiction of the myocardial bridge muscle. 1 Exercise stress testing, nuclear scintigraphy, coronary flow reserve evaluation by echocardiography, fractional flow reserve measurement, and myocardial perfusion imaging may be helpful in assessing the clinical relevance of myocardial bridging in affected patients.…”

Symptomatic Myocardial Bridging in D-Transposition of the Great Arteries Post-Arterial Switch

“…Although a prior case of myocardial bridging in a patient with d-TGA post–atrial switch has been reported, ours is the first of significant myocardial bridging in patients post–arterial switch. 2 …”