Left anterior descending coronary artery bridge: contraindication to cardiac transplantation?

We report two cases of cardiac transplantation of donor hearts with left anterior descending (LAD) myocardial bridging (MB). In the first case, the diagnosis was done only days after transplant. In the second case, a pre-operative angiography showed evidence of LAD myocardial bridging and the organ was used for a marginal recipient. Both patients tolerated the procedure very well and did not have peri-operative cardiac complications. In this study, MB is discussed and its relationship to rejection of donor hearts is evaluated. In light of the growing demand for donated hearts, and in consideration of the relatively high and often undiagnosed occurrence of MB, a liberalized approach to acceptance of this anatomic variant could be adopted in the selection of donor hearts. Identification of MB in the prospective donor heart should not be an absolute contraindication for transplantation.