Extremely Deep Myocardial Bridge With Fixed-Like Coronary Stenosis.

IMAGE(S): Electrocardiography, coronary computed tomography angiography, coronary angiography, and intravascular ultrasound (IVUS) findings in an extremely deep left anterior descending myocardial bridge. CASE SUMMARY: A 56-year-old woman had exertional chest pain with transient anterior ST-segment elevation. Coronary computed tomography angiography showed a 7.5-mm-deep mid-left anterior descending bridge. Angiography showed persistent narrowing without a milking effect. IVUS demonstrated a perimedial high-echoic band and bilateral perimedial high-echogenicity, supporting persistent compression. Surgical unroofing was considered high risk, and conservative therapy was chosen. TAKE-HOME MESSAGES: Deep myocardial bridging can mimic fixed stenosis. IVUS can help identify persistent compression in atypical bridged segments.