A rare case of a patient with a myocardial bridge in combination with bicuspid valve and subaortic stenosis.
DOI:
https://doi.org/10.2478/AMB-2024-0079Keywords:
myocardial bridge, bicuspid aortic valve, subvalvular aortic stenosisAbstract
Combined congenital heart defects in adults are very rare, and knowledge of their diagnostic-therapeutic approach is of interest to specialists. Subaortic stenosis (SAS) is a heart disease of unclear etiology and variable clinical manifestation. In some cases, SAS is described in combination with a congenital bicuspid aortic valve, but a real rarity is the combination of the listed lesions with the non-obstructive coronary stenosis caused by a myocardial bridge. A middle-aged woman with chest pain and dyspnea during minimal physical exertion, that subsides after rest, was referred for surgery. Two-dimensional transthoracic echocardiography demonstrated a slightly left ventricular hypertrophy with preserved systolic function without anomalies of cardiac wall motion. A dynamic gradient is observed in the left ventricular outflow tract reaching up to 90mmHg. Bicuspid aortic valve is presented with high-grade regurgitation. The picture of myocardial ischemia is complemented by selective coronary angiography demonstrating a rarely presented myocardial bridge over the left anterior descending coronary artery. The diagnostic approach and surgical corrections performed are the subject of this report.
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