CONGRESS ABSTRACT

Background: Myocardial Bridging (MB) is a congenital condition characterized by the intramyocardial course of a coronary artery.  It is often asymptomatic, but ischemic symptoms can occur, and are related to the compression, during the systolic phase, of the tunneled segment. Case Summary: A 40-year-old female triathlete came to our attention complaining of dyspnea, palpitations and typical angina induced by mild-moderate physical exercise starting after in vitro fertilization (IVF) treatments. Her medical history was negative for cardiovascular diseases and did not include diabetes, hypertension, dyslipidemia and smoking habits. ECG stress test, annually performed during the pre-participation screening, did not reveal abnormalities in the ST-T segment and no other signs of inducible myocardial ischemia. Our investigations included a coronary CT angiography (CCTA) that showed a long and deep MB of the left anterior descending coronary artery. Therefore, it was necessary to determine whether the bridging resulted in myocardial ischemia. Particularly, according to the ESC and Italian guidelines, participation in competitive sports is recommended only in absence of inducible ischemia. The Myocardial Single Photon Emission Computed Tomography (SPECT) detected an extensive stress-induced perfusion defect involving the inferior and the anterior-apical wall. A coronary artery bypass grafting was needed to solve the condition, allowing athlete to participate in competitive sports again. Discussion and Conclusions: IVF treatment has been recently associated with an increased rate of postpartum hospitalization due to heart diseases, including ischemic ones: it has been hypothesized that the non-physiological ovarian stimulation causes acute hemodynamic changes, primarily due to the impairment of the renin–angiotensin–aldosterone axis. Moreover, most ovarian stimulation protocols alter endothelial cell function because of the poor bioavailability of Nitric Oxide (NO) and impaired levels of Relaxin, a peptide hormone involved in the regulation of vascular tone and fluid balance. In the present case, this decreased release of molecules with a vasodilatory activity probably altered compensation mechanisms downstream of the coronary artery tunneled segment resulting in a symptomatic exercise induced ischemia. In athletes resolutive surgical treatments for MB should be preferred to allow participation in competitive sports again.