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Myocardial bridging of the left anterior descending coronary artery

Case contributed by Vougiouklis Nikos
Diagnosis certain

Presentation

Underwent computed coronary angiography for suspected coronary disease.

Patient Data

Age: 45 years
Gender: Male

Myocardial bridging of the left anterior descending artery displayed by volume rendering technique during diastole. Due to the intramyocardial course of the middle segment of the LAD, this particular segment is not imaged.

The curved planar reformatted CT angiogram shows minimal stenosis (arrow) of the LAD in the intramyocardial segment during late diastole (segment 760 ms). The stenosis increases during systole (segment 404 ms).

The oblique axial section during systole reveals the compressed segment.

Case Discussion

Myocardial bridging is the intramyocardial course of a coronary artery. The decrease of the diameter of this particular segment during systole is called "milking effect" and carries an increased risk of thrombus formation and vasospasm. Myocardial bridging usually is found in the left anterior descending artery (LAD). This anatomic variant may alter the technique of coronary surgery or even cause complications.

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