European Journal of Echocardiography 2007 8(4):284-288; doi:10.1016/j.euje.2006.02.011
Copyright © 2006, The European Society of Cardiology
Noninvasive assessment of myocardial bridging in the left coronary artery by transthoracic Doppler echocardiography
Nurcan Arat*,
Hakan Altay,
Nesligul Yildirim,
Erdogan Ilkay and
Irfan Sabah
Department of Cardiology, Türkiye Yüksek Ihtisas Hospital, Shihiye 06100, Ankara, Turkey
Received 13 December 2005; received in revised form 27 December 2005; accepted after revision 28 February 2006.
* Corresponding author. Present address: Koza Sokak No: 84/56, Büyük Esat, 06700 Ankara, Turkey. nurcanarat{at}superonline.com
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Abstract
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Myocardial bridging is a common congenital coronary abnormality
recognized primarily with systolic narrowing or ‘milking
effect’ shown by coronary angiography. We report the case
of a 58-year-old man with signs and symptoms of myocardial ischemia
who underwent transthoracic echocardiography and coronary angiography.
The present case suggests the clinical role of transthoracic
echocardiography in demonstrating characteristic coronary flow
abnormalities in patients with muscular bridge in the region
of the mid LAD.
Keywords: Myocardial bridge; Transthoracic Doppler echocardiography
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Introduction
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Myocardial bridge (MB) is diagnosed in vivo by angiography when
a systolic compression of a coronary artery which disappears
during diastole is evidenced. Quantitative coronary angiography,
intracoronary Doppler studies and intravascular ultrasonography
have revealed characteristics and pathophysiologic processes
in MB.
1–3 Transthoracic echocardiography (TTE) is a new
and promising diagnostic tool in imaging coronary arteries,
4 nonetheless, no informed data could be found about its use in
imaging myocardial bridge. In this case report, we presented
a patient with symptoms of ischemia associated with MB which
was detected by transthoracic echocardiography.
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Case report
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A 58-year-old man was referred to our institution for the evaluation
of dyspnea, syncope and stable angina pectoris which showed
an increase after the initiation of nitrate therapy. His cardiac
examination and electrocardiography were normal. Blood count,
biochemical parameters including cardiac enzyme and troponin
levels were also normal. Chest X-ray showed mildly increased
cardiothoracic ratio. Transthoracic echocardiography demonstrated
relaxative type diastolic dysfunction with normal systolic and
diastolic left ventricle internal diameters. Interventricular
septum and left ventricle wall thicknesses were mildly increased.
However, there was no wall motion abnormality and significant
valvular pathology. Coronary flow velocity recordings were measured
with a Vivid 7 Dimension ultrasound scanner (GE Vingmed, Horten,
Norway) using a high 3.5mHz transthoracic transducer (
Figs. 1–4
).
The diagnosis of MB was confirmed by coronary angiography (
Figs. 5 and 6).
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Figure 1 Via Doppler color flow mapping guidance, coronary blood flow in the mid of the LAD was identified as a color-filled tubular structure in the anterior interventricular sulcus. The segment distal to it showed turbulence in the color flow signal which was detected to be running intramurally through the myocardium.
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Discussion
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In this case report, typical coronary flow findings, which were
previously defined by intravascular Doppler study,
3 were also
demonstrated by TTE. Evident systolic reverse flow proximal
to MB, decreased diastolic flow velocity and lack of systolic
flow distal to MB were demonstrated. The role of TTE for the
evaluation of MB should be further investigated by prospective
studies.
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References
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- Jorge R., Alegria J.R., Herrmann J., Holmes D.R. Jr., Lerman A., Rihal C.S. Myocardial bridging. Eur Heart J (2005) 26:1159–1168.[Abstract/Free Full Text]
- Kneale B.J., Stewart A.J., Coltart D.J. A case of myocardial bridging: evaluation using intracoronary ultrasound, Doppler flow measurement, and quantitative coronary angiography. Heart (1996) 76:374–376.[Free Full Text]
- Bourassa M.G., Butnaru A., Lesperance J., Tardif J.C. Symptomatic myocardial bridges: overview of ischemic mechanisms and current diagnostic and treatment strategies. J Am Coll Cardiol (2003) 41:351–359.[Abstract/Free Full Text]
- Krzànowski M., Bodzon W., Dimitrow P.P. Imaging of all three coronary arteries by transthoracic echocardiography. An illustrated guide. Cardiovasc Ultrasound (2003) 1:16.[CrossRef][Medline]
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Abstract
Introduction
