Introduction
For the same case, Shuichiro Yamauchi, a cardiologist at our hospital, has published a previous paper on the usefulness of perioperative coronary angiography (CAG) and fractional flow reserve (FFR) using high-dose dobutamine infusion as a diagnosis of myocardial bridge (MB) [1]. Surgical techniques are also very useful, so I would like to report this case focusing on surgical techniques.
In MB, the muscular bridge results in systolic compression of the tunneled portion of the coronary artery and infrequently causes myocardial ischemia and sudden death [2].  As a surgical method of MB, coronary artery bypass grafting (CABG) is reported to be most beneficial in long or deep MB. In the absence of long or deep bridges, surgical unroofing of the overlying muscle fibers is an effective option. Unroofing is generally performed under cardio-pulmonary bypass support or cardioplegic arrest [3]. Though minimally invasive approach is beneficial for patients with MB, there is a limited number of reports.
Herein, we present a case of minimally invasive off-pump unroofing via left mini-thoracotomy for MB of the left anterior descending coronary artery (LAD). We had written consent from the patient about this case report. IRB number is B202112-01 and date of approval is 12/23/2021.