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

Sumeet S Vaikunth1,2, Daniel J Murphy3, Jennifer A Tremmel4

  • 1Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

JACC. Case Reports
|March 2, 2023
PubMed

Insights

Chest pain after arterial switch surgery may indicate myocardial bridging. Doctors should assess for this nonobstructive coronary condition alongside standard checks for coronary ostial patency.

Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Congenital Heart Disease

Background:

  • The arterial switch operation (ASO) is a common surgical procedure for treating transposition of the great arteries.
  • Post-ASO patients may experience various complications, including coronary artery issues.
  • Chest pain is a concerning symptom in the post-ASO population.

Observation:

  • This study reviews Stanford's experience with patients experiencing chest pain after ASO.
  • A subset of these patients was diagnosed with hemodynamically significant myocardial bridging.
  • Myocardial bridging involves a segment of a coronary artery tunneled within the heart muscle.

Findings:

  • Hemodynamically significant myocardial bridging can cause chest pain in post-ASO patients.
  • This condition may be overlooked if only coronary ostial patency is assessed.
  • Myocardial bridging represents a nonobstructive coronary anomaly that requires consideration.

Implications:

  • Diagnostic protocols for symptomatic post-ASO patients should include evaluation for myocardial bridging.
  • Early identification and management of myocardial bridging can improve patient outcomes.
  • This highlights the importance of considering a broader spectrum of coronary pathologies beyond ostial stenosis.

Keywords:
ASO, arterial switch operationCCTA, coronary computed tomography angiographyFFR, fractional flow reserveIVUS, intravascular ultrasoundLAD, left anterior descending arterySPECT, single-photon emission computed tomographychest paincoronary vessel anomalyd-TGA, dextro-transposition of the great arteriesdFFR, diastolic fractional flow reservetransposition of the great arteries

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