Abstract
Although intracoronary stenting procedures have been advocated for the successful treatment of myocardial ischaemia associated with myocardial bridging, the physiological rationale for this approach remains unexplored. The case of a 70 year old man with symptoms of cardiac ischaemia associated with a left anterior descending coronary artery bridge is described, where use of an intracoronary stent abolished the angiographic abnormalities and also restituted pronounced abnormalities of coronary fractional flow reserve. Keywords: angioplasty; myocardial bridge; coronary flow reserve; stent
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Figure 1 .
Top: Angiographic appearances of the left anterior descending coronary artery (lateral projection) in systole (left) and diastole (right). Myocardial bridging was associated with complete obliteration of the arterial lumen during systole (arrow). Bottom: Simultaneous pressure recordings (phasic and mean) obtained from the right femoral artery and the left anterior descending coronary artery distal to the site of myocardial bridging, before (A) and after (B) administration of intracoronary adenosine (20 µg). Coronary fractional flow reserve, expressed as the ratio of mean coronary arterial pressure (y) to mean aortic pressure (x), was significantly reduced (0.65, normal > 0.75) following adenosine, confirming the functional significance of the bridged segment.
Figure 2 .
Angiographic appearances and simultaneous pressure recordings obtained following successful balloon angioplasty and stent deployment (format as for fig 1). Note the approximation of the mean pressure recordings with minimal change in response to intracoronary adenosine, confirming an improvement in normal fractional flow reserve, and restoration of a morphologically normal pressure trace distal to the treated segment.