Pericardial adhesions simulating myocardial bridging

Area of Science:

• Cardiovascular Surgery
• Diagnostic Imaging
• Cardiac Anatomy

Background:

• Myocardial bridging is a congenital anomaly where a segment of a coronary artery courses through the heart muscle.
• Preoperative diagnosis often relies on coronary angiography, which can reveal the extent and severity of the bridging.
• Aortic valve disease necessitates careful preoperative evaluation, including assessment of coronary artery anatomy.

Observation:

• A 48-year-old male patient with known aortic valve disease underwent preoperative coronary angiography.
• The angiography suggested the presence of myocardial bridging.
• Surgical exploration for aortic valve repair revealed only pericardial adhesions, with no evidence of myocardial bridging or abnormal epicardial coronary artery course.

Findings:

• Coronary angiography indicated myocardial bridging, but surgical findings did not confirm its presence.
• Pericardial adhesions were noted during surgery, unrelated to the suspected coronary anomaly.
• The epicardial coronary arteries followed a normal anatomical course upon direct visualization.

Implications:

• This case underscores the importance of correlating imaging findings with surgical exploration in complex cardiac cases.
• Discrepancies between preoperative angiography and intraoperative findings for myocardial bridging can occur.
• Further investigation into the sensitivity and specificity of coronary angiography in diagnosing myocardial bridging may be warranted.