Bridging of the left anterior descending artery
45 year-old patient underwent 64-slice computed tomography coronary angiography (CTCA) for suspected coronary artery disease.
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Myocardial bridging of LAD displayed by volume rendering technique. Due to the intermyocardial course of the middle segment of LAD this particular segment is not imaged.
Curved planar reformatting CT angiography shows minimal stenosis (arrow) in the middle segment of LAD in the intermyocardial segment during late diastole (segment 760) . The stenosis increases during systole (segment 404 msec ). Oblique axial section reveals the compressed segment.
Myocardial bridging is defined as a segment of a major epicardial coronary artery that goes intramurally through the myocardium beneath the muscle bridge (intramyocardial course).
"Milking" is the term used when the diameter of the segment decreases during systole. Myocardial bridging is generally confined to the left anterior descending artery (LAD), and the main angiographic finding is systolic compression of the involved epicardial coronary artery.
Myocardial bridging has been considered a benign condition, but some complications have been reported such as ischemia, acute coronary syndromes, arrhythmias and sudden death.
When coronary surgery is planned, it is essential to know the precise intramuscular course of the artery to avoid complications, such as perforation of the right ventricular wall, when exposure of the intramuscular arterial segment is attempted.