Contemporary evidence of coronary atherosclerotic disease and myocardial bridge on left anterior descending artery in a patient with a nonobstructive hypertrophic cardiomyopathy. Journal of cardiovascular medicine (Hagerstown, Md.) [J Cardiovasc Med (Hagerstown)] Journal article | | Title | Contemporary evidence of coronary atherosclerotic disease and myocardial bridge on left anterior descending artery in a patient with a nonobstructive hypertrophic cardiomyopathy. | | Author(s) | Calabrò P, Bianchi R, Caprile M, Bigazzi MC, Sordelli C, Palmieri R, Dʼalessandro R, Golia E, Limongelli G, Pacileo G, Calabrò R | | Institution | Division of Cardiology, Department of Cardiothoracic Sciences, Second University of Naples, Monaldi Hospital, Naples, Italy. | | Source | J Cardiovasc Med (Hagerstown) 2009 Oct 23. | | Abstract | In patients with hypertrophic cardiomyopathy (HCM) a high incidence of myocardial bridge is reported, with prevalence up to 35%, and the prognosis is not clear. We report a case of a 46-year-old man with nonobstructive HCM who, in the previous 6 months, complained of dyspnea and typical angina. Physical stress echocardiography was negative; however, due to the worsening of symptoms at rest, we decided to perform a coronary angiography. An 80% stenosis was detected at the proximal segment of the left anterior descending artery (LAD); 3 cm distal to this lesion, a dynamic (systolic) narrowing of the coronary arterial lumen was detected, suggesting a myocardial bridge. This finding was confirmed by performing an intravascular ultrasound (IVUS) examination. The atherosclerotic lesion of the proximal LAD was treated with a sirolimus-eluting stent. Postimplantation IVUS analysis showed that the stent was circular and fully expanded. The patient was discharged in good clinical condition. On return of milder symptoms, a 6-month follow-up coronary angiography was performed, which confirmed the presence of the bridge and the good apposition of the previously implanted stent. At a follow-up of 12 months, the patient is symptom free. In conclusion, the particularity of our case is the contemporary presence of a myocardial bridge in the mid part of the LAD and of an atherosclerotic plaque determining significant stenosis in the proximal LAD, far from and apparently not related to the myocardial bridge. Recently, a model has been proposed in which increased axial wall stress could be responsible for the development of atheroma in the proximal segment of myocardial bridges. However, there are still controversies regarding its pathophysiology. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19858731 |
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