Myotomy After Previous Coronary Artery Bypass Grafting for Treatment of Myocardial Bridging

A 57-year-old man with a long history of frequent chest pain was admitted to our cardiac center. Four years ago, he underwent coronary artery bypass grafting (CABG) with the left internal mammary artery (LIMA) to the distal segment of the left anterior descending coronary artery (LAD) grafting for myocardial bridging (MB) in LAD despite having β-blockers and calcium channel blockers. However, the patient still had recurrent angina within 3 months after the operation. ECG showed negative T wave in leads V1 and V2. On echocardiography, left ventricular ejection fraction was 60% with normal regional wall motion. The repeat coronary angiography showed a MB in the proximal LAD about 3 cm in length with 90% systolic narrowing of the LAD, and the LIMA graft was totally occluded (Figure 1A through 1C). The …