Late Gadolinium Enhancement on Cardiac Magnetic Resonance Imaging in Acute Myocardial Infarction Due to Myocardial Bridging: A Clinical Dilemma
Journal Title: Journal of Advances in Medicine and Medical Research - Year 2014, Vol 4, Issue 22
Abstract
A 51-year-old male with a family history of premature coronary artery disease (CAD) presented with acute myocardial infarction (AMI) with coronary angiography demonstrating no angiographic disease and a mid-left anterior descending (LAD) myocardial bridging (MB) segment with 71% mean lumen diameter (MLD) compression. Due to continually rising biomarkers and recurrent angina, cardiac magnetic resonance imaging(CMR) was obtained demonstrating late gadolinium enhancement (LGE) involving the mid-distal LAD territory. Patient subsequently underwent successful percutaneous coronary intervention (PCI) with drug-eluting stent (DES) to the MB segment with resolution of symptoms, which persisted over a year. MBis defined as an intramuscular segment resulting in overlying bands of myocardium, also called “tunneled” artery. Once thought benign, MB has been reported to cause unstable angina, AMI, life-threatening arrhythmias, and sudden cardiac death. PCI has been reported to relieve symptoms balanced against rates of in-stent restenosis and target lesion revascularization as high as 19% with DES. This case illustrates the utility of CMR in the setting of AMI to guide decision to purse PCI in symptomatic MB.
Authors and Affiliations
Michelle L. Zielinski, Homayoun R. Ahmadian, Travis C. Batts, Ahmad M. Slim, Dustin M. Thomas
Keywords
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- EP ID EP349410
- DOI 10.9734/BJMMR/2014/10208
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