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

Marcel A M Beijk1, Janneke Woudstra1, A Suzanne Vink1

  • 1Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.

JACC. Case Reports
|June 6, 2024
PubMed

Insights

Two patients with angina and no obstructive coronary artery disease found myocardial bridging. Coronary artery unroofing successfully treated their persistent symptoms.

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.

Keywords:
angina with no obstructive coronary artery diseasemyocardial bridgingmyotomysurgical unroofingvasospastic angina

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