Coronary Artery Tortuosity With Coexisting Multiple Myocardial Bridges: A Cadaveric Case Report

Coronary artery tortuosity (CAT) and myocardial bridging are common anatomical variants often considered benign; however, both may alter coronary blood flow. Their extensive coexistence throughout the coronary arterial tree has rarely been reported. During routine cadaveric dissection of a 91-year-old female donor, severe diffuse CAT and multiple myocardial bridges were identified. The left anterior descending (LAD) artery, circumflex (Cx) artery, right coronary artery (RCA), posterior descending artery (PDA), acute marginal artery (AMA), and several major branches demonstrated marked tortuosity characterized by numerous looping and S-shaped configurations. The LAD demonstrated 11 bends; the AMA and PDA, eight each; the diagonal artery, seven; the circumflex artery, five; the obtuse marginal artery, four; and the proximal RCA, three. Four myocardial bridges were present: two over the LAD and one each over the AMA and PDA. Several looping segments appeared anchored to the myocardium by bridges or perforating branches. Despite the donor's advanced age, the coronary arteries exhibited no gross evidence of calcification or hardening. Additional findings included thin-walled translucent arterial segments and symmetrical pectus excavatum. This rare combination may have important clinical implications. The coexistence of myocardial bridges and CAT may alter coronary blood flow, while the associated pectus excavatum and translucent arterial walls may suggest an underlying connective tissue abnormality. Recognition of these complex coronary variations is important for accurate diagnosis, procedural planning, and surgical intervention.