Myocardial Bridging on CT @Universal - Dr. Shanavaskhan Shamsudeenkutty, Consultant - Cardiovascular Disease

The coronary arteries may dip into the myocardium for varying lengths, and then reappear on the heart surface. The muscle overlying the intramyocardial segment of the epicardial coronary artery is termed a myocardial bridge (MB), and the artery running within the myocardium is referred to as a tunneled artery.  Although MBs can be found in any epicardial artery, most of them involve the left anterior descending artery. These congenital coronary anomalies have long been recognized anatomically, and are  traditionally considered a benign condition; however, the association between myocardial ischemia and MBs has increased their clinical relevance.

Cardiac computed tomography (CCT), with its multiplane and 3-dimensional capabilities, has significantly improved the detection rate of MB.

LAD-MBs may significantly differ anatomically with respect to depth (superficial: >1 to 2 mm vs. deep: >2 mm) and length of encasement.

NORMAL LAD COURSE

Case Study:  A young 34-year-old male with complaint of chest pain worsening with exertion and activity and a stress test clinically positive for inducible ischemia underwent a CT angiogram which revealed Myocardial Bridging – thickness of 3 mm and encasement (intramyocardial segment) of 1 cm.

MYOCARDIAL BRIDGING OF THE LAD

Dr. Shanavaskhan Shamsudeenkutty

Consultant - Cardiovascular Disease