JACC Case Rep. 2026 Jul 17:109238. doi: 10.1016/j.jaccas.2026.109238. Online ahead of print.
ABSTRACT
BACKGROUND: Myocardial bridging in adult patients with congenital heart disease is rare.
CASE SUMMARY: A 21-year-old man with d-transposition of the great arteries who underwent the Senning procedure presented with exertional fatigue and chest pain. Medical examination revealed ascending aortic stenosis and myocardial bridging of the left anterior descending artery. The patient underwent ascending aortic replacement and coronary artery bypass grafting by saphenous vein-free right internal mammary artery graft. Postoperative examination demonstrated excellent graft patency and improvement of ischemia.
DISCUSSION: This case highlights a rare presentation of symptomatic myocardial bridging decades after the Senning procedure. Careful graft selection and design are essential to achieve durable revascularization in young patients.
TAKE-HOME MESSAGES: Myocardial bridging should be considered as a potential cause of myocardial ischemia in adult patients with congenital heart disease. When myotomy is technically challenging or high-risk, carefully planned coronary artery bypass grafting with an appropriate graft strategy can provide effective revascularization.
PMID:42467042 | DOI:10.1016/j.jaccas.2026.109238