Multiple Bands of Myocardial Bridging Involving the Left Anterior Descending and Posterior Descending Arteries: A Case Report and Its Clinical Implications.

Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of a coronary artery tunnels through the myocardium, potentially leading to ischemia, arrhythmias, or other clinical complications. While typically benign and most often involving a single band over the left anterior descending (LAD) artery, multiple myocardial bridges and involvement of other arteries, such as the posterior descending artery (PDA), represent rare anatomical variations. During a routine dissection at the William Carey University College of Osteopathic Medicine, multiple MB bands were observed in a 65-year-old male cadaver. Three distinct, thin myocardial bridges were identified over the LAD artery. Additionally, a single, thick myocardial bridge was found over the PDA. Notably, the LAD displayed a unique course, turning onto the inferior surface of the heart. The coronary circulation was right-dominant, and a pacemaker was present, with leads extending to the right atrium and right ventricle. No other structural abnormalities were noted. This case aligns with literature documenting variable MB presentations but stands out due to the coexistence of multiple bridges over the LAD and a separate, deep bridge over the PDA. These anatomical features may have contributed to the need for pacemaker placement, suggesting a history of conduction system dysfunction. The findings support previous observations that MB can be associated with arrhythmias and may complicate coronary blood flow. Diagnostic and therapeutic strategies vary widely depending on the extent and functional impact of MB. Awareness of such variations is crucial for accurate diagnosis, risk assessment, and interventional planning in cardiology and cardiothoracic surgery.