Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2022; 10(12): 3828-3833
Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3828
Evaluation of intracoronary function after reduction of ventricular rate by esmolol in severe stenotic myocardial bridge: A case report
Long-Jun Sun, Ding-Guang Yan, Shu-Wei Huang
Long-Jun Sun, Ding-Guang Yan, Shu-Wei Huang, Department of Cardiovascular Medicine, Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
Author contributions: Sun JL conceived and wrote this report; Sun JL and Huang SW operated on the patients; Sun JL, Yan GD organized the data; and Huang SW revised the paper; all authors have read and approved the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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Corresponding author: Shu-Wei Huang, Doctor, Department of Cardiovascular Medicine, First Affiliated Hospital of Zhejiang Chinese Medical University, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, Zhejiang Province, China. hsw1104@163.com
Received: July 17, 2021
Peer-review started: July 17, 2021
First decision: December 9, 2021
Revised: December 18, 2021
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: April 26, 2022
Processing time: 278 Days and 0.4 Hours
Abstract
BACKGROUND

Severe stenotic myocardial bridges (MBs) have been reported to lead to intracoronary ischaemia, but the physiological evaluation of MBs using intracoronary function evaluation indicators after intraoperative drug treatment has not been fully established.

CASE SUMMARY

We performed through snuff fossa for coronary angiography in a patient with chest tightness after repeated exercise, and the results showed that the middle part of the anterior descending branch was a MB with 100% systolic compression. The intracoronary function evaluation (defined as the ratio of distal coronary pressure to aortic pressure with zero microcirculation resistance) was instantaneous wave-free ratio (IFR) without drug and fractional flow reserve (FFR) with adenosine. The IFR was 0.73, and the FFR was 0.66. Then esmolol 0.02 µg/kg/min was intravenously injected. The IFR and FFR were measured again when the heart rate dropped to 60 beats/min. The IFR was 0.83, and the FFR 0.65.

CONCLUSION

This case report is a case of isolated MB with severe stenosis. After intraoperative drug treatment decreased the ventricular rate, an increase in the coronary function evaluation index was immediately observed to confirm the effective improvement of coronary blood flow.

Keywords: Myocardial bridge, FFR, IFR, Drug therapy, Coronary artery disease, Angiography, Coronary, Case report

Core Tip: Myocardial bridge is one of the causes of myocardial ischaemia, and some studies have found that the degree of ischaemia is positively correlated with the degree of systolic compression. In this case of severe stenosis, after intraoperative drugs reduced the ventricular rate of the patient, the coronary ischaemia improved. This is a relatively novel change in coronary function that was determined by evaluation indices.