Multimodality Assessment of a Culprit LAD Myocardial Bridge in a Patient With Congenital Heart Disease

Myocardial bridging is a congenital coronary anomaly in which a segment of an epicardial artery is tunneled within the myocardium. Although many cases remain asymptomatic, hemodynamically significant bridges may require surgical intervention.

A 57-year-old man with a history of an unrepaired ventricular septal defect presented with recurrent chest pain. Initial imaging identified a 4.7-cm myocardial bridge in the left anterior descending artery. Functional testing with fractional flow reserve, instantaneous wave-free ratio, and diastolic hyperemia-free ratio confirmed hemodynamic significance. Optical coherence tomography was performed to further visualize the segment. The patient underwent successful surgical unroofing, resulting in complete symptom resolution.

This case highlights a multimodal intracoronary approach incorporating intracoronary anatomical and physiological testing to determine the hemodynamic significance of myocardial bridging.

Multimodal intracoronary anatomical and physiological testing is imperative for diagnosing myocardial bridges in patients presenting with undifferentiated angina, thereby influencing management.