Aim

Patients with myocardial bridging is generally accompanied with abnormal ST segment or T wave changes either on resting ECG or exercise stress test. It was reported that various types of myocardial abnormalities including localized or generalized thickening or disarray of myocytes, papillary hypertrophy, and etc. are uniquely represented with similar ST or T wave changes on 12 lead surface ECG. Recently it was reported that the myocardium under the myocardial bridging segment had demonstrated increased fibrosis in a postmortem study. We had observed non-ischemic originated lineer type myocardial enhancement areas just under the myocardial bridge segments which similar to the recently reported data. We aimed to present and discuss the the probability of MB being a type of cardiomyopathy characterized with progressive myocardial fibrosis.

We referred two cases that presented with prominent ECG changes and were diagnosed as myocardial bridging (MB) on LAD artery. Since ECG changes were very prominent patients were referred to cardiac MR in order to evaluate a co-existing cardiomyopathy or a presence of myocardial ischemia due to MB. It was reported that linear areas with late enhancements on the segments corresponded to myocardial region on which MB was present. Additionally it was reported that those findings were compatible with neither ischemic origin nor myocarditis.

We presented those ECG changes and Cardiac MR images.

Case 1

A 38 years old male had down-sloping ST segment depression on inferior lateral leads of ECG and normal findings on echocardiography. He had 3 cm length based myocardial bridging which was causing moderately luminal narrowing on the mid segment of LAD artery on MSCT Angiography. MPS was negative about ischemia. Cardiac MRI revealed linear enhancement areas which were not related with ischemia.