Faculty, Staff and Student Publications

Language

English

Publication Date

3-20-2026

Journal

JACC: Case Reports

DOI

10.1016/j.jaccas.2026.107536

PMID

41860495

Abstract

Background: Myocardial bridging is a congenital coronary anomaly in which a segment of an epicardial artery is tunneled within the myocardium. Although many cases remain asymptomatic, hemodynamically significant bridges may require surgical intervention.

Case summary: A 57-year-old man with a history of an unrepaired ventricular septal defect presented with recurrent chest pain. Initial imaging identified a 4.7-cm myocardial bridge in the left anterior descending artery. Functional testing with fractional flow reserve, instantaneous wave-free ratio, and diastolic hyperemia-free ratio confirmed hemodynamic significance. Optical coherence tomography was performed to further visualize the segment. The patient underwent successful surgical unroofing, resulting in complete symptom resolution.

Discussion: This case highlights a multimodal intracoronary approach incorporating intracoronary anatomical and physiological testing to determine the hemodynamic significance of myocardial bridging.

Take-home message: Multimodal intracoronary anatomical and physiological testing is imperative for diagnosing myocardial bridges in patients presenting with undifferentiated angina, thereby influencing management.

Keywords

case, diastolic hyperemia-free ratio, fractional flow reserve, instantaneous wave-free ratio, myocardial bridge, optical coherence tomography

Published Open-Access

yes

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