Coronary Artery Anomalies, Myocardial Bridging Associated with Fistula to Pulmonary Artery Trunk. Case Reports

Abstract

Between coronary artery anomalies, myocardial bridging means an epicardial coronary artery, mostly Left Anterior Descending artery (LAD), running through intramyocardial “tunnel” (usually in the middle segment), leading during systolic contraction, flow reduction, through the vessel. When this anomaly is associated with a coronary fistula, who “steal” more from the bloodstream, the symptoms are more pronounced and the management complex, surgical in particular. Despite the presence from birth remains a symptomatic and it becomes clinically manifest later in the third to fourth decade of the life, with a diverse palette of symptoms; angina, arrhythmias, acute myocardial infarction up to sudden death. Diagnosis and particular management, medical, interventional and surgical should avoid major cardiac complications and sudden death. We present two adult patients, with coronary artery bridging, one case associated with coronary artery fistula, LAD to pulmonary artery trunk, very symptomatic with surgical management and the second only myocardial bridging controlled with medication and supervision.