A Rare Case of a Patient with a Myocardial Bridge in Combination with Bicuspid Valve and Subaortic Stenosis

Combined congenital heart defects in adults are very rare, and knowledge of their diagnostic-therapeutic approach is of interest to specialists. Subaortic stenosis (SAS) is a heart disease of unclear etiology and variable clinical manifestation. In some cases, SAS is described in combination with a congenital bicuspid aortic valve, but a real rarity is the combination of the listed lesions with the non-obstructive coronary stenosis caused by a myocardial bridge. A middle-aged woman with chest pain and dyspnea during minimal physical exertion, that subsides after rest, was referred for surgery. Two-dimensional transthoracic echocardiography demonstrated left ventricular hypertrophy with preserved systolic function without anomalies of cardiac wall motion. A dynamic gradient was observed in the left ventricular outflow tract reaching up to 90 mmHg. Bicuspid aortic valve was presented with high-grade regurgitation. The picture of myocardial ischemia was complemented by selective coronary angiography demonstrating a rarely presented myocardial bridge over the left anterior descending coronary artery. The diagnostic approach and surgical corrections performed are the subject of this report.