Key result
Surgical unroofing of myocardial bridging resolves angina and normalizes ischemic FFRCT from 0.76.
Why the study?
Unlike invasive FFR, FFRCT had not been validated for the physiological evaluation of an isolated myocardial bridge.
Does surgical unroofing improve FFRCT values and resolve anginal symptoms in a patient with a symptomatic long and deep myocardial bridge of the LAD?
Case Report (n=1)
No
Does surgical unroofing improve FFRCT values and resolve anginal symptoms in a patient with a symptomatic long and deep myocardial bridge of the LAD?
FFRCT can be a useful non-invasive technique to evaluate the physiological significance of myocardial bridges and to confirm the restoration of coronary blood flow following surgical unroofing.
FFRCT may track response to unroofing in symptomatic bridges; leaves open its role in guiding therapy without prospective data.
Background Cardiac computed tomography angiography derived fractional flow reserve (FFRCT) is a diastolic measurement and has emerged as a valuable non-invasive alternative to FFR in patients with stable coronary artery disease. It has, unlike FFR during coronary angiography, not been validated for the physiological evaluation of an isolated myocardial bridge (MB) so far. Case summary Our patient, previously known with a long myocardial bridge of the mid-segment of the left anterior descending artery, presented with a non-ST-segment elevation myocardial infarction that was treated by surgical unroofing of the MB. FFRCT after surgery confirms a major amelioration of coronary blood flow. Discussion Myocardial bridge may rarely present as a non-ST-segment elevation myocardial infarction. FFRCT has thus far been accepted as a useful diagnostic tool in stable coronary artery disease. Our case report suggests that cardiac computed tomography angiography may be considered a useful technique for anatomical and physiological evaluation of MBs.
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Martens et al. (2023) conducted a case report in Myocardial bridge presenting with non-ST-segment elevation myocardial infarction (n=1). Surgical unroofing (supra-arterial myotomy) vs. Pre-surgical baseline was evaluated on Cardiac computed tomography angiography derived fractional flow reserve (FFRCT). Surgical unroofing of a deep and long myocardial bridge resolved anginal symptoms and normalized the FFRCT value from an ischemic baseline of 0.76.
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