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Coronary Artery Bypass Grafting for Myocardial Bridging 21 Years After the Senning Procedure
Hisashi Yoshida1, Azumi Hamasaki1, Michinobu Nagao2
1Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Insights
Myocardial bridging, a rare condition in adults with congenital heart disease, can cause chest pain. Coronary artery bypass grafting effectively treated a patient with d-transposition of the great arteries and myocardial bridging.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Vascular Surgery
Background:
- Myocardial bridging is uncommon in adults with congenital heart disease.
- Adult congenital heart disease patients may present with rare complications.
- The Senning procedure is a common surgical repair for d-transposition of the great arteries.
Background:
Myocardial bridging in adult patients with congenital heart disease is rare.
Case Summary:
A 21-year-old man with d-transposition of the great arteries who underwent the Senning procedure presented with exertional fatigue and chest pain. Medical examination revealed ascending aortic stenosis and myocardial bridging of the left anterior descending artery. The patient underwent ascending aortic replacement and coronary artery bypass grafting by saphenous vein-free right internal mammary artery graft. Postoperative examination demonstrated excellent graft patency and improvement of ischemia.
Discussion:
This case highlights a rare presentation of symptomatic myocardial bridging decades after the Senning procedure. Careful graft selection and design are essential to achieve durable revascularization in young patients.
Take-Home Messages:
Myocardial bridging should be considered as a potential cause of myocardial ischemia in adult patients with congenital heart disease. When myotomy is technically challenging or high-risk, carefully planned coronary artery bypass grafting with an appropriate graft strategy can provide effective revascularization.
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