technetium-tc-99m-tetrofosmin and Myocardial-Bridging

Myocardial bridging is a congenital anomaly in which a segment of a coronary artery runs intramuscularly. Although traditionally considered as a benign condition, myocardial bridging may be associated with clinically important complications such as myocardial ischemia, acute coronary syndromes and sudden death. We report the case of a highly symptomatic 36 years old patient with a myocardial bridge in left anterior descending coronary artery in which surgical treatment was proposed. Previous to surgery a non invasive coronariography with cardiac CT was practised in order to define the anatomy.

Topics: Adult; Angina Pectoris; Cardiac Surgical Procedures; Coronary Angiography; Coronary Vessels; Humans; Male; Myocardial Bridging; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Treatment Outcome

Myocardial bridging is a congenital abnormality characterized by an intramyocardial course of a major epicardial coronary artery segment. Generally considered a benign condition, myocardial bridging has been associated with angina, acute myocardial infarction, and sudden death. Herein, we report a patient with an intramyocardial segment in the mid portion of the left anterior descending coronary artery with marked systolic compression. Single photon emission computed tomography with technetium-99m tetrofosmin done to evaluate an episode of chest pain showed a large predominantly fixed perfusion defect in the mid to apical anterior wall with partial reversibility. The patient's chest pain did not recur and repeat single photon emission computed tomography imaging 14 days later with rest-redistribution thallium-201 showed normal myocardial perfusion. The overall clinical impression was that myocardial bridging resulted in severe transient anterior myocardial hypoperfusion. The literature on prevalence, diagnosis, use of perfusion imaging, and hemodynamic effects of myocardial bridging is reviewed.

Topics: Adenosine; Coronary Circulation; Coronary Vessel Anomalies; Hemodynamics; Humans; Male; Middle Aged; Myocardial Bridging; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Thallium Radioisotopes