Myocardial Bridge or Something Else?

Area of Science:

• Cardiology
• Cardiovascular Surgery

Background:

• Myocardial bridges (MB) are common in hypertrophic cardiomyopathy (HCM).
• HCM presents with diverse phenotypes, complicating the diagnosis of latent left ventricular outflow tract obstruction.
• Exertional dyspnea and angina can be symptoms of underlying cardiac conditions.

Purpose of the Study:

• To report a case of myocardial bridge (MB) requiring surgical unroofing.
• To discuss the association between MB and hypertrophic cardiomyopathy (HCM).
• To emphasize the importance of identifying phenotypic variants of HCM for diagnosing outflow tract obstruction.

Main Methods:

• Intraoperative transesophageal echocardiography.
• Provocative maneuvers during echocardiography.
• Surgical unroofing of myocardial bridge.

Main Results:

• Systolic anterior motion of the mitral valve with septal contact was observed.
• Left ventricular outflow tract obstruction was identified.
• Obstruction occurred despite the absence of significant basal septal hypertrophy.

Conclusions:

• Myocardial bridges can be associated with hypertrophic cardiomyopathy.
• Recognizing diverse HCM phenotypes is essential for diagnosing outflow tract obstruction.
• A high index of suspicion is necessary for identifying latent obstruction in HCM patients.