Myocardial bridging of the posterolateral branches of the right coronary artery

A 57-year-old male patient presented with typical exertional angina and dyspnea during usual physical activities. He had a history of hypertension. On cardiac examination, he had a load ejection-type systolic murmur which was radiating to both carotid arteries. Transthoracic echocardiography revealed severe calcified aortic stenosis and severe concentric left ventricular hypertrophy. He underwent coronary angiography to define his coronary anatomy before aortic valve replacement. The left anterior descending (LAD) artery had non-significant stenosis after the first diagonal branch, and the left circumflex (LCx) artery was normal. The right coronary artery (RCA) injection demonstrated myocardial bridging of a long segment of the posterolateral branches with complete luminal obliteration during systole (Figures 1 and 2). He underwent surgical aortic valve replacement without right posterolateral myotomy or bypass graft surgery. Beta-blocker was prescribed following surgery to reduce the potential risk of ischemia and arrhythmia.