A heart with multiple coronaries anomalies: myocardial bridging, left dominance and high takeoff of ostia-an autopsy case.

Myocardial bridging is a segment of coronary artery that runs intramurally through the myocardium. Though it is commonly seen in the anterior interventricular artery and less commonly in right coronary artery, it can cause limitation in the blood flow, which leads to myocardial ischaemia. Left dominance increases cardiac mortality because of association with the congenital bicuspid aortic valve and myocardial infarction. An earlier study has shown the correlation of myocardial bridging with left coronary circulation and it is rare in relation with right coronary and left dominance. Manifestations of high takeoff of the coronary ostia are highly debatable, with varied opinions given by various authors. It has been believed that myocardial bridging is congenital and that it also causes limitation of blood flow to the myocardium. Cardiac muscles have a unique capability to adapt in response to decreased blood supply, which is in the form of coronary collateral circulation. So, is their any correlation between myocardial bridging and dominance? Herein, we are reporting an unusual autopsy case of myocardial bridging on its right main coronary artery, left coronary dominance and high take off of left main coronary artery in the same heart.