Bridging the unseen: A tale of multivessel myocardial bridges in rheumatic mitral stenosis

ABSTRACT Myocardial bridging is a congenital anomaly of the coronary arteries in which a segment of the artery runs within the heart muscle and is compressed during the contraction phase of the heart. This case report discusses a middle-aged woman with a history of severe rheumatic mitral stenosis who underwent open commissurotomy. The patient presented with dyspnea and palpitations. General examination revealed sinus tachycardia, a loud first heart sound, and a mid-diastolic murmur. Echocardiography revealed a normal left ventricular ejection fraction and severe rheumatic mitral stenosis. Coronary angiography revealed normal coronary arteries with myocardial bridges (MBs) in the mid-left anterior descending artery, distal left circumflex artery, and distal right coronary artery. These observations were confirmed by cardiac computed tomography. This case report contributes to the limited literature on multivessel MBs and highlights the importance of thorough diagnostic assessments to optimize individualized treatment plans for patients.