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Intraoperative coronary angiography and fractional flow reserve measurement with dobutamine infusion in supra-arterial myotomy for a myocardial bridge: a case report

BACKGROUND: A myocardial bridge (MB) is a congenital coronary anomaly, wherein the epicardial coronary artery tunnels through the myocardial band. Treatment is indicated when clinical symptoms occur, and β-blockers are the first choice of treatment. Symptomatic patients refractory to medical therapy...

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Autores principales: Yamauchi, Shuichiro, Hayashida, Akihiro, Hirohata, Atsushi, Sakaguchi, Taichi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343443/
https://www.ncbi.nlm.nih.gov/pubmed/34377914
http://dx.doi.org/10.1093/ehjcr/ytab268
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author Yamauchi, Shuichiro
Hayashida, Akihiro
Hirohata, Atsushi
Sakaguchi, Taichi
author_facet Yamauchi, Shuichiro
Hayashida, Akihiro
Hirohata, Atsushi
Sakaguchi, Taichi
author_sort Yamauchi, Shuichiro
collection PubMed
description BACKGROUND: A myocardial bridge (MB) is a congenital coronary anomaly, wherein the epicardial coronary artery tunnels through the myocardial band. Treatment is indicated when clinical symptoms occur, and β-blockers are the first choice of treatment. Symptomatic patients refractory to medical therapy are considered for other options, including stent placement, coronary artery bypass grafting, or surgical supra-arterial myotomy. Supra-arterial myotomy is effective; however, the symptoms might persist if myocardial resection is inadequately performed. CASE SUMMARY: We encountered a patient experiencing exertional chest pain. Coronary angiography revealed a MB at the mid-left anterior descending artery with systolic compression. The patient’s fractional flow reserves (FFRs) were 0.93 at rest and 0.72 with intravenous administration of 50 µg/kg/min dobutamine. The symptoms were refractory to drugs, and supra-arterial myotomy was performed with intraoperative coronary artery angiography, which revealed the milking effect of the residual myocardium; therefore, additional myocardial resection was performed. Postoperative coronary artery angiography showed no systolic compression, and the postoperative FFRs were 0.88 at rest and 0.92 with intravenous administration of dobutamine 50 µg/kg/min. DISCUSSION: Although surgical supra-arterial myotomy is safe and effective, inadequate myocardial resection might cause symptom recurrence. Intraoperative coronary artery angiography during the surgery can indicate whether additional resection is required. Objective assessment of ischaemia might be useful in cases with a MB, which can cause asymptomatic myocardial ischaemia and sudden cardiac death. FFRs before surgery can help in evaluating the need for surgery and for confirming the therapeutic effect and subsequent treatment.
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spelling pubmed-83434432021-08-09 Intraoperative coronary angiography and fractional flow reserve measurement with dobutamine infusion in supra-arterial myotomy for a myocardial bridge: a case report Yamauchi, Shuichiro Hayashida, Akihiro Hirohata, Atsushi Sakaguchi, Taichi Eur Heart J Case Rep Case Report BACKGROUND: A myocardial bridge (MB) is a congenital coronary anomaly, wherein the epicardial coronary artery tunnels through the myocardial band. Treatment is indicated when clinical symptoms occur, and β-blockers are the first choice of treatment. Symptomatic patients refractory to medical therapy are considered for other options, including stent placement, coronary artery bypass grafting, or surgical supra-arterial myotomy. Supra-arterial myotomy is effective; however, the symptoms might persist if myocardial resection is inadequately performed. CASE SUMMARY: We encountered a patient experiencing exertional chest pain. Coronary angiography revealed a MB at the mid-left anterior descending artery with systolic compression. The patient’s fractional flow reserves (FFRs) were 0.93 at rest and 0.72 with intravenous administration of 50 µg/kg/min dobutamine. The symptoms were refractory to drugs, and supra-arterial myotomy was performed with intraoperative coronary artery angiography, which revealed the milking effect of the residual myocardium; therefore, additional myocardial resection was performed. Postoperative coronary artery angiography showed no systolic compression, and the postoperative FFRs were 0.88 at rest and 0.92 with intravenous administration of dobutamine 50 µg/kg/min. DISCUSSION: Although surgical supra-arterial myotomy is safe and effective, inadequate myocardial resection might cause symptom recurrence. Intraoperative coronary artery angiography during the surgery can indicate whether additional resection is required. Objective assessment of ischaemia might be useful in cases with a MB, which can cause asymptomatic myocardial ischaemia and sudden cardiac death. FFRs before surgery can help in evaluating the need for surgery and for confirming the therapeutic effect and subsequent treatment. Oxford University Press 2021-07-26 /pmc/articles/PMC8343443/ /pubmed/34377914 http://dx.doi.org/10.1093/ehjcr/ytab268 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Yamauchi, Shuichiro
Hayashida, Akihiro
Hirohata, Atsushi
Sakaguchi, Taichi
Intraoperative coronary angiography and fractional flow reserve measurement with dobutamine infusion in supra-arterial myotomy for a myocardial bridge: a case report
title Intraoperative coronary angiography and fractional flow reserve measurement with dobutamine infusion in supra-arterial myotomy for a myocardial bridge: a case report
title_full Intraoperative coronary angiography and fractional flow reserve measurement with dobutamine infusion in supra-arterial myotomy for a myocardial bridge: a case report
title_fullStr Intraoperative coronary angiography and fractional flow reserve measurement with dobutamine infusion in supra-arterial myotomy for a myocardial bridge: a case report
title_full_unstemmed Intraoperative coronary angiography and fractional flow reserve measurement with dobutamine infusion in supra-arterial myotomy for a myocardial bridge: a case report
title_short Intraoperative coronary angiography and fractional flow reserve measurement with dobutamine infusion in supra-arterial myotomy for a myocardial bridge: a case report
title_sort intraoperative coronary angiography and fractional flow reserve measurement with dobutamine infusion in supra-arterial myotomy for a myocardial bridge: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343443/
https://www.ncbi.nlm.nih.gov/pubmed/34377914
http://dx.doi.org/10.1093/ehjcr/ytab268
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