Myocardial Bridging as a Trigger in Angina With No Obstructive Coronary Artery Disease

Area of Science:

• Cardiology
• Cardiovascular Surgery

Background:

• Angina pectoris is a common condition often associated with obstructive coronary artery disease.
• Non-obstructive coronary artery disease (CAD) presents a diagnostic challenge, particularly when symptoms persist despite optimal medical management.

Observation:

• Two patients presented with refractory angina despite maximal pharmacotherapy.
• Coronary angiography revealed no obstructive coronary artery disease in either patient.
• Myocardial bridging was identified as a potential contributing factor to their ischemic symptoms.

Findings:

• Invasive hemodynamic assessment confirmed the role of myocardial bridging in causing angina.
• Both patients underwent successful coronary artery unroofing surgery.
• Surgical intervention provided symptomatic relief, indicating the efficacy of the procedure.

Implications:

• Myocardial bridging should be considered in the differential diagnosis of angina with non-obstructive CAD.
• Coronary artery unroofing is a viable surgical option for managing symptomatic myocardial bridging.
• This case series highlights the importance of comprehensive invasive assessment for refractory angina.