• Xiaobin Wang, Hassan Rastegar, Ethan J Rowin, Michael Robich, Luis Fernando Gonzalez-Ciccarelli, and Frederick C Cobey.
• Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111.
• J. Cardiothorac. Vasc. Anesth. 2022 Jan 1; 36 (1): 332-337.

AbstractIn this E-Challenge, the authors report on a patient with symptoms of exertional dyspnea and angina, scheduled to have surgical unroofing of an identified myocardial bridge (MB). An MB is very common in patients with hypertrophic cardiomyopathy (HCM). Intraoperative transesophageal echocardiography with provocative maneuvers revealed the patient had a systolic anterior motion of the mitral valve with septal contact and resulting outflow tract obstruction despite the notable absence of significant basal septal hypertrophy. HCM has many phenotypic variants that can make the identification of patients with latent left ventricular outflow tract obstruction difficult in the absence of a high index of suspicion. In this report, the authors discuss the association between MBs and HCM and the importance of recognizing phenotypic variants of HCM.Copyright © 2021 Elsevier Inc. All rights reserved.

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