Li HH, Liu MW, Zhang YF, Song BC, Zhu ZC, Zhao FH. Myocardial bridging phenomenon is not invariable: A case report. World J Clin Cases 2022; 10(29): 10721-10727 [PMID: 36312505 DOI: 10.12998/wjcc.v10.i29.10721]
Corresponding Author of This Article
Fu-Hai Zhao, MD, Chief Doctor, Department of Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medicine Science, National Clinical Research Center for Chinese Medicine Cardiology, No. 1 Xiyuancaochang, Haidian District, Beijing 100091, China. 13911134962@163.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hao-Hao Li, Graduate School of Beijing University of Chinese Medicine, Beijing 100029, China
Ming-Wang Liu, Yang-Fang Zhang, Bo-Ce Song, Zheng-Chuan Zhu, Fu-Hai Zhao, Department of Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medicine Science, National Clinical Research Center for Chinese Medicine Cardiology, Beijing 100091, China
Author contributions: Li HH designed and wrote the report; Zhao FH guided the writing of the report and revised it; Liu MW contributed to constructive discussions; Zhang YF, Song BC, and Zhu ZC assisted with the data management; All authors have read and approved the final manuscript.
Informed consent statement: The patient provided oral and written informed consent prior to study enrolment.
Conflict-of-interest statement: All authors declare no conflicts of interest.
CARE Checklist (2016) statement: All authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Hai Zhao, MD, Chief Doctor, Department of Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medicine Science, National Clinical Research Center for Chinese Medicine Cardiology, No. 1 Xiyuancaochang, Haidian District, Beijing 100091, China. 13911134962@163.com
Received: May 27, 2022 Peer-review started: May 27, 2022 First decision: June 27, 2022 Revised: July 10, 2022 Accepted: August 25, 2022 Article in press: August 25, 2022 Published online: October 16, 2022 Processing time: 124 Days and 18.6 Hours
Abstract
BACKGROUND
Myocardial bridging is a common anatomical malformation, and the milking effect is a characteristic phenomenon of myocardial bridging in coronary angiography. Generally, the phenomenon is invariable. However, this article reports an inconceivably rare myocardial bridging phenomenon that breaks through our conventional views. The milking effect changed obviously in two coronary angiography examinations, which subverted the traditional deep-rooted view of the myocardial bridging phenomenon and revealed the limitations of coronary angiography in diagnosing myocardial bridging and judging the prognosis of it.
CASE SUMMARY
A 63-year-old man was diagnosed with ST-segment elevation myocardial infarction and received primary percutaneous coronary intervention on December 26, 2019. His heart rate was 104 beats per minute, and blood pressure was 15.3/10.3 kPa. A severe milking effect was found in the left anterior descending coronary artery during his index coronary angiography on January 14, 2020. The patient was given intensive medical management, including a β1-adrenergic receptor blocker, during hospitalization and after discharge. Unexpectedly, coronary angiography showed that the previous impressive milking effect was dramatically alleviated (close to normal) at the follow-up on October 13, 2020. At that moment, the patient’s heart rate was 83 beats per minute, and blood pressure was 12.7/8.0 kPa.
CONCLUSION
The myocardial bridging phenomenon is not invariable and, in certain circumstances, may vary. Furthermore, the autonomic nervous system may be involved in the myocardial bridging phenomenon.
Core Tip: Myocardial bridging is a common anatomical malformation. Coronary angiography is considered the routine method to diagnose myocardial bridging, and the milking effect is a characteristic phenomenon of myocardial bridging in coronary angiography. Myocardial bridging is generally classified as superficial or deep according to anatomical features, which can be manifested by the milking effect. While the milking effect is generally invariable, our case surprisingly showed that the milking effect is not invariable. In certain circumstances, the myocardial bridging phenomenon may vary, which can mislead us into judging the prognosis of myocardial bridging. Therefore, it is necessary to perceive myocardial bridging phenomenon anew.
