Myocardial Bridging With Left Ventricular Hypertrophy

Figures

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  Figure 1. Contrast-Enhanced Computed Tomography at Initial Presentation and 2-Month Follow-up (A) Initial contrast-enhanced computed tomography (CT) showing nonenhanced areas extending from the left ventricular anterior wall to the interventricular septum, suggestive of ischemic injury. (B) Follow-up CT at 2 months demonstrating no lesion area progression.

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  Figure 2. Echocardiography Showing Left Ventricular Hypertrophy, Particularly in the Anterior Wall and Interventricular Septum, With Mild Hypokinetic Wall Motion Abnormality in the Same Region

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  Figure 3. Electrocardiogram Revealing Extensive ST-Segment Depression Upon Admission, Indicative of Myocardial Ischemia

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  Figure 4. Coronary Angiography Pre- and Post- Surgical Unroofing of MB Coronary angiography in diastole (A) and systole (B) illustrating a significant squeezing phenomenon due to myocardial bridging (MB) in the mid–left anterior descending artery. (C) Acetylcholine provocation testing inducing severe epicardial spasm, leading to subtotal occlusion at the distal left anterior descending artery. Intraoperative coronary angiography in diastole (D) and systole (E) under dobutamine stress confirming successful surgical unroofing of MB.

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  Figure 5. Cardiac Magnetic Resonance at Initial Presentation and 2-Month Follow-Up Cardiac magnetic resonance (A) showing thickening of the anterior left ventricular wall and interventricular septum (15-19 mm) with late gadolinium enhancement on the endocardial side (B). (C) Follow-up cardiac magnetic resonance at 2 months showing no lesion area progression.

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  Figure 6. Coronary Computed Tomography Illustrating the Mid–Left Anterior Descending Artery Embedded Within the Thickened Myocardium Over a Length of 3 cm and a Depth of 1 cm, Consistent With Prominent Myocardial Bridging

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  Figure 7. Physiological Assessment of Myocardial Bridging-Induced Ischemia Pressure wire analysis showed a resting full-cycle ratio (RFR) of 0.87 (A), decreasing to 0.73 during dobutamine stress (B), confirming stress-induced myocardial ischemia. (C) RFR pullback revealed a paradoxical increase in systolic coronary pressure distal to the myocardial bridging (MB) and normalization of coronary pressure proximal to the MB, consistent with the hemodynamic compromise in this segment.

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  Figure 8. Fluorodeoxyglucose Positron Emission Tomography Demonstrating Extensive Tracer Uptake in the Anterior Left Ventricular Wall and Interventricular Septum

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  Figure 9. Intraoperative Findings of Surgical Unroofing