Encasement of the Left Anterior Descending Coronary Artery: Association with Takotsubo Syndrome, and Diagnostic and Therapeutic Options

Myocardial bridging is a rare event, which leads to chest pain, arrhythmias and discussable takotsubo syndrome (cardiomyopathy). We collected 41 patients (33 females, mean age 68.4 years) with all forms of takotsubo cardiomyopathy in most cases and 6 cases with chest pain and echocardiographic mid-ventricular hypokinesia. Left ventricular angiography revealed apical ballooning in 30 patients, mid-ventricular ballooning in 3 cases, and basal ballooning in one case. The correct diagnosis of myocardial bridging can be best made by intravascular ultrasound (IVUS) and fractional flow reserve (FFR) with either adenosine or dobutamine injection. Beyond atherosclerosis, myocardial bridging is a prominent cause of chest pain, although ischemia is difficult to verify.