Value of advanced CCTA post-processing in identifying differences in the LAD myocardial bridging anatomy

Coronary arteries typically demonstrate an epicardial course but in some instances they are encased by the myocardium which defines myocardial bridging (MB), a congenital coronary anomaly that mostly affects the left anterior descending artery (LAD) and it has variable prevalence ranging from 5% to 86% in autopsy studies. 1 Konen E. Goitein O. Sternik L. Eshet Y. Shemesh J. Di Segni E. The prevalence and anatomical patterns of intramuscular coronary arteries. J Am Coll Cardiol. 2007; 49: 587-593 Crossref PubMed Scopus (140) Google Scholar MB may lead to myocardial ischemia mainly in the setting of rapid heart rate by compressing the involved vessel that results in diastolic flow impairment, coronary microvascular dysfunction and reduced coronary flow reserve. 2 Murtaza G. Mukherjee D. Gharacholou S.M. Nanjundappa A. Lavie C.J. Khan A.A. et al. An updated review on myocardial bridging. Cardiovasc Revascularizat Med. 2020; 21: 1169-1179 Crossref Scopus (26) Google Scholar Although patients with MB carry a favorable prognosis, 2 Murtaza G. Mukherjee D. Gharacholou S.M. Nanjundappa A. Lavie C.J. Khan A.A. et al. An updated review on myocardial bridging. Cardiovasc Revascularizat Med. 2020; 21: 1169-1179 Crossref Scopus (26) Google Scholar diagnosing the condition is important in choosing the appropriate therapy for the symptomatic group. Cardiac Computed Tomography Angiogram Interventricular septum Left anterior descending artery Myocardial bridging Right ventricular Three-dimensional volume rendered