冠状动脉心肌桥的检出率及临床分析

目的:分析冠状动脉心肌桥的检出率及其临床特点。方法:回顾性分析冠状动脉造影检测出的53例心肌桥病例的临床资料。结果:冠状动脉造影发现心肌桥的检出率为3.29%(53/1610),心肌桥患者并发冠心病的发生率约为26.4%,孤立性心肌桥与心肌桥并发冠心病在传统的冠心病易患因素方面无统计学差异(P0.05),但在收缩期壁冠状动脉狭窄程度与心肌桥长度方面差异有显著统计学意义(P0.01)。结论:经冠状动脉造影,心肌桥的检出率为3.29%,心肌桥患者心肌桥长度与收缩期壁冠状动脉狭窄程度可能是心肌桥并发冠心病的危险因素。     

冠状动脉心肌桥的临床意义

目的:探讨冠状动脉心肌桥的临床意义。方法:回顾分析接受选择性冠状动脉造影的756例病人中检出的82例(10.8%)有心肌桥患者的资料。结果:82例心肌桥患者临床表现为稳定型心绞痛者10例(12.2%),不稳定型心绞痛者33例(40.2%),不明原因的胸痛者34例(41.5%),急性心肌梗塞者3例(3.7%),肥厚型心肌病者2例(2.4%);心肌桥近端存在冠状动脉狭窄者23例(28.0%),心肌桥远端存在冠状动脉狭窄者3例(3.7%),孤立性心肌桥(无冠脉狭窄)者46例(56.1%)。结论:心肌桥的发生率高,可导致心肌缺血,引起心绞痛;对临床疑诊心绞痛的病人应尽早常规行冠状动脉造影检查。     

Stent procedure complicated by thrombus formation distal to the lesion within a muscle bridge

We report here a case of a patient who underwent percutaneous intervention to the left anterior descending artery, complicated by thrombus formation within the myocardial bridge distal to the lesion. There was complete angiographic resolution of thrombus and restoration of the normal antegrade blood flow after infusion of glycoprotein IIb/IIIa antagonist (abciximab). Our observation may suggest that the presence of myocardial bridging distal to coronary lesions should be considered seriously in preprocedural evaluation of the lesions as a potential risk factor for intracoronary thrombus formation. The main coronary arteries and the proximal segments of their major branches lie free on the epicardial surface of the heart. However, in some instances these vessels may penetrate into the muscle being surrounded by the myocardium, with the overlying muscle referred to as a “bridge”. Myocardial bridging appears to be a congenital anomaly, due to failure of exteriorization of the primitive coronary intratrabecular arterial network. It occurs in 5-86% of patients in autopsy studies [1-3], and it is observed as systolic coronary artery narrowing in 0.5-12% of patients undergoing coronary arteriography [3]. Although the gross anatomist had long recognized that the epicardial coronary artery might on occasion course directly through a segment of cardiac muscle, the physiological significance of this phenomenon was considered benign [4]. This is partly because traditional teaching concerning coronary blood flow delivery to the left ventricular myocardium emphasized the primacy of the diastolic phase of the cardiac cycle. However, myocardial bridging is not always a benign finding, with recent reports suggesting an association with myocardial ischemia, infarction, vasospasm, cardiac arrythmias, and sudden death [3,5]. Cathet. Cardiovasc. Diagn. 43:73–76, 1998. © 1998 Wiley-Liss, Inc.     

Clinical and angiographic profile and follow-up of myocardial bridges: a study of 21 cases

Myocardial bridging describes an angiographic entity, which is any degree of systolic narrowing of a coronary artery observed in at least one angiographic projection. Among the cineangiograms of 3200 patients reviewed, there were 21 cases (19 males) of myocardial bridges--incidence of 0.6 percent. Of these, seven had hypertrophic cardiomyopathy, six had atherosclerotic coronary artery disease and remaining eight had no evidence of either. All 21 patients had myocardial bridges in proximal or mid left anterior descending coronary artery. In addition, one case of hypertrophic cardiomyopathy had whole posterior descending coronary artery under a myocardial bridge. Another case of hypertrophic cardiomyopathy had a short normal segment of 5 mm inside a long myocardial bridge of 35 mm (tandem myocardial bridges). The length of the bridges varied from 10 to 35 mm (mean 24.5 +/- 4.5 mm) and diameter stenosis during systole varied from 40-90 percent (mean 70 +/- 8%). Two patients had large saccular coronary aneurysms proximal to the muscle bridge. Four of the eight patients who had neither hypertrophic cardiomyopathy nor coronary artery disease presented with acute anterior wall myocardial infarction and three of them had regional wall motion abnormality of left descending territory. Of the six patients who had coronary artery disease, one had 60 percent left descending artery lesion and two had recanalized segments proximal to the bridge. Five of the above six patients had significant stenosis of other coronary vessels. Four patients were lost to follow-up (mean period 3.4 +/- 2 years). In the coronary artery disease group, one patient underwent coronary artery bypass graft surgery for 3-vessel disease including graft to left descending artery and one developed inferior wall myocardial infarction. The patients in the hypertrophic cardiomyopathy group and "no hypertrophic cardiomyopathy-no coronary artery disease" group were free of events at last follow-up. Long-term prognosis of isolated myocardial bridges appears to be excellent. Degree of systolic narrowing or length of myocardial bridge does not correlate with event rates on follow-up.     

Coronary artery thrombosis in patients with unstable angina.

This report describes the clinical course, coronary artery anatomy, and ventricular function of 16 patients in whom coronary artery thrombosis was detected at the time of cardiac catheterisation. All patients had an unstable clinical course in which accelerated angina occurred a mean of four weeks (range four days to 12 weeks) before catheterisation, and four patients had recent subendocardial myocardial infarction. In all patients severe coronary artery disease was documented at catheterisation. Fifteen patients had segmental wall motion abnormalities involving the left ventricular wall that was supplied by the coronary artery in which there was thrombus. Three patterns of coronary artery thrombus were noted: (1) Thrombus proximal to high-grade coronary artery stenosis; (2) thrombus distal to high-grade coronary artery stenosis; and (3) thrombus in segments of the arterial tree in which there was no high-grade coronary artery stenosis. Though the precise cause of the coronary artery thrombosis in our patients is unknown, it may have been a result of stasis, a ruptured atherosclerotic plaque, or coronary spasm. The common clinical course with unstable angina of acute onset suggests the possibility that the thrombus may have been responsible for the abrupt change in clinical condition or may have been a contributing factor in the patients' course.     

Angina pectoris and muscular bridges on the anterior interventricular artery. Apropos of 3 operated cases]

A relationship between ischaemia of the myocardium and a muscular bridge over the anterios descending artery has now been demonstrated. The authors report three cases in which the severity of the clinical features was sufficient to justify surgical division of the muscular bridge without touching the underlying artery. Progress remained satisfactory after a follow-up period of 1.5 to 3 years. The opportunity is taken to discuss the role of the muscle bridge in causing pathology in the coronary arterial system.     

肌桥所致心肌缺血机制与治疗

目的研究冠状动脉心肌桥患者心肌缺血机制和治疗措施。方法回顾性分析390例左前降支冠状动脉心肌桥患者的临床特点。根据心脏收缩期桥段血管受压的轻重程度分为两组：A组235例,收缩期压迫〈50％;B组135例,收缩期压迫≥50％。对比两组患者心血管危险因素以及冠状动脉粥样硬化的发生率。结果390例左前降支冠状动脉肌桥近段血管动脉粥样硬化发生率为45．70％,远段血管动脉粥样硬化发生率为2．25％,两者差异有统计学意义（P〈0．05）。两组患者年龄、性别、高血压、高脂血症、家族史、吸烟史方面比较均无统计学意义（P〉0．05）。B组与A组相比,心肌桥近段血管动脉粥样硬化发生率明显增加,差异有统计学意义（P〈0．05）。结论①肌桥患者心肌缺血的主要机制是肌桥收缩时的挤压和肌桥近端动脉粥样硬化。②对靶血管进行再血管化是治疗心肌桥患者较为合理而有效的方法。     

心肌桥对冠状动脉粥样硬化的作用

目的:探讨心肌桥与冠状动脉粥样硬化病变之间的关系。方法:回顾性分析冠脉造影术中检出的心肌桥患者92例的冠脉病变与临床资料。结果:1500例冠脉造影患者检出心肌桥92例,检出率6.1%;心肌桥近段冠状动脉粥样硬化病变发生率71.7%,远段冠状动脉粥样硬化病变发生率10.9%,两者差异有显著性（P<0.01）。结论:心肌桥可能导致冠状动脉心肌桥近段冠脉粥样硬化病变。     

Coronary artery anomalies in tetralogy of Fallot patients evaluated by multi slice computed tomography; myocardial bridge is not a rare finding

Based on coronary angiography and interoperative inspection, anomalous origin of coronary artery crossing the right ventricular outflow tract (RVOT) is common in tetralogy of Fallot (TOF) patients. However, other coronary anomalies may be underestimated due to the overlying myocardium, epicardial fat, or adhesions due to previous palliative surgery. Currently, coronary artery visibility dramatically improved by multislice computed tomography (MSCT). We performed this study to assess the coronary arteries anatomy in TOF patients using MSCT.All TOF patients underwent MSCT examination at our centre from 2013 till 2019 were included. Assessment of the coronary arteries’ origin and course were performed. Presence of myocardial bridge were assessed, and indexed RV mass was calculated.318 TOF patients were included, median age 2 years (range 1 month–46 years), 175 males (55%). The abnormal coronary artery origin and course were detected in 20 patients (6%); coronary artery crossed RVOT in 13 patients (65%), 5 patients (25%) had a retro-aortic course and 2 patient (10%) had inter-arterial course. Myocardial bridges of left anterior descending artery or/and right coronary artery were reported in 100 patients (36%), no myocardial bridge of left circumflex was reported. RV mass was 29.0 ± 21.1 g/m². There was no correlation between RV mass and presence of myocardial bridges.MSCT is a useful imaging modality for detection of coronary arteries anomalies in TOF patients. Coronary artery crossing RVOT is not the only abnormal course and myocardial bridging is not a rare finding. Further studies are needed to demonstrate the clinical significance of these observations.     

Intra-aortic balloon counterpulsation for complex aortic stenosis in hybrid strategy

Intra-aortic balloon pumping (IABP) has been considered to be relatively contraindicated in patients with complex aortic stenosis (AS). In this report, we describe the successful implementation of IABP counterpulsation in a patient with severe coronary artery disease and left ventricular dysfunction complicating significant aortic AS. It is shown that adjuvant IABP is a safe and effective method to bridge the unstable hemodynamic condition in the initial percutaneous phase of a hybrid approach. One year after second stage valve surgery, the clinical course remains uneventful.     

Variations in 35SO4 incorporation into glycosaminoglycans along canine coronary arteries. A possible index of artery wall stress.

Focal areas of accentuated wall stress along the course of canine coronary arteries may be revealed by the level of 35SO4 incorporation into glycosaminoglycans (GAG). In the anterior descending artery, 35SO4 incorporation in higher in the proximal than in the distal region and may be extraordinarily high as the vessel enters a proximally located muscle bridge and at the takeoff region of multidirectional branches. In the circumflex artery, the incorporation also is higher in the proximal than in the distal region and is high at the genu where the posterior descending artery forms. There are differences in uptake of 35SO4 in vessels even when the arteries arise from the same vascular bed.this was shown by the higher incorporation in the left coronary artery than in the right coronary artery. A general anatomical agreement exists between these sites of high 35SO4 incorporation and previously described locations of interval elastic disruption ans proliferation of intimal connective tissue in the dog.     

Characteristic clinical findings of reversible left ventricular dysfunction

OBJECTIVE: In this study, clinical findings were evaluated in 16 patients with reversible left ventricular dysfunction (RLVD) who showed a clinical picture similar to that of acute myocardial infarction, in addition to akinesis or dyskinesis of the left ventricular apex without showing any abnormalities in the coronary artery. RESULTS: The frequency of RLVD was markedly higher in women than in men in these 16 patients (men:women = 1:7). In addition, these patients showed ECG changes similar to those observed in ischemic heart diseases, such as ST elevation or depression, negative T waves and QT prolongation. However, the serum cardiac markers were only slightly increased, and no specific changes were detected by histological examinations of the heart muscle. CONCLUSION: These patients also showed a clinical picture similar to the stunned myocardium caused by myocardial ischemia. However, the frequency of RLVD was higher in women than in men compared to the frequency of other coronary artery diseases, and there was no severe stenosis in the coronary artery. Moreover, most of these patients showed negative results for the coronary spasm provocation test. Therefore, RLVD may be an atypical ischemic heart disease if it is caused by coronary arteriosclerosis. Since RLVD developed during the course of other diseases or under severe mental stress, autonomic nerves may be involved in the etiology of RLVD. Furthermore, 2 patients who received the coronary spasm provocation test during the acute phase showed positive results. Therefore, other factors that transiently increase the sensitivity of the coronary artery may also be involved in the etiology of RLVD.     

Coronary artery disease in twins.

In two pairs of monozygotic twins with coronary artery disease who were studied by coronary angiography, there were striking similarities in the clinical course, response to exercise, and distribution of coronary artery disease. Though it is difficult to distinguish between heredity as an independent risk factor and the other major risk factors, the similarities in each twin pair may be best explained by identical heredity.     

Does isolated myocardial bridge really interfere with coronary blood flow?

BackgroundMyocardial bridge (MB) is defined as a segment of a major epicardial coronary artery the “tunneled artery” that goes intramurally through the myocardium beneath the muscle bridge. Multiple methods have been proposed to assess coronary flow rate among which thrombolysis in acute myocardial infarction frame count was a relatively new semiquantitative method.ObjectivesOur goal was to determine incidence of MB in the patients undergoing coronary angiography in Mansoura Specialized Hospital, Cardiac Catheterization Laboratory, also to investigate the hypothesis that slow coronary flow rate may be linked to angina or angina like symptoms in patients with MB without stenotic lesions in epicardial coronary arteries using TFC.Patients and methodsFifteen patients with MB (group I) were retrospectively collected from Mansoura Specialized Hospital, Cardiac Catheterization Laboratory, we review 3000 cases referred to diagnostic coronary angiography to exclude significant coronary artery disease. Fifteen patients with normal coronary angiography served as control (group II). We review the clinical presentations, risk factors, echocardiographic data for both test and control groups. TFC was calculated using a simple continuous index.ResultsThe incidence of MB in our study was 0.5%. CTFC in LAD was significantly higher in the patients with MB compared with control. No significant correlation between TFC and echocardiographic parameters.ConclusionsMyocardial bridging must be considered especially in patients at low risk for coronary atherosclerosis but with angina like chest pain or established myocardial ischemia. We suggest that coronary blood flow is decreased in the patients with MB compared with the patients having normal coronary.     

Odynophagia in a woman with known coronary artery disease and ischemia on electrocardiogram

Esophageal intramural hematoma can mimic other causes of chest pain. When the patient is known to have coronary artery disease, the diagnosis may be difficult. Moreover, the course may be complicated and may harm the patient if antiplatelet drugs, thrombolytics, and anticoagulants are used. The presence of odynophagia should alert the clinician to the possibility of an esophageal origin, even in a patient with known coronary artery disease. We present a case in which early recognition of the clinical presentation prevented potential iatrogenic complications.     

Coronary myocardial bridge: an innocent bystander?

Myocardial bridge (MB) or tunneled coronary artery is an inborn abnormality, which implicates a systolic vessel compression with a persistent mid-late diastolic diameter reduction. Myocardial bridges are often observed during coronary angiography with an incidence of 0.5%-5.5%. The most involved coronary artery is the left anterior descending artery followed by the diagonal branches, the right coronary artery, and the left circumflex. The overall long-term prognosis is generally benign. However, several risk or precipitating factors (e.g., high heart rate, left ventricular hypertrophy, decreased peripheral vascular resistance) may trigger symptoms (most frequently angina). Herein, we describe two cases of symptomatic myocardial bridge, where medical treatment (i.e., inotropic negative drug) and coronary stenting were successfully utilized to treat this pathology. We also focus on the clinical presentation, and the diagnostic and therapeutic modalities to correctly manage this frequently observed congenital coronary abnormality, underlining the fact that in cases of typical angina symptoms without any significant coronary artery disease, MB should be considered as a possible differential diagnosis.     

69例冠状动脉心肌桥临床分析

目的　分析冠状动脉造影病人中心肌桥的发生率以及临床特征。方法和结果　 1678例行选择性冠状动脉造影术的人群中 ,共检出心肌桥 69例 ,发生率为 4.11%。均为左冠状动脉前降支 ( L AD)心肌桥。位于 L AD近段 1例 ,中段 5 7例 ,远段 11例。伴有冠心病的心肌桥 13例 ,伴有瓣膜病 3例 ,伴有心肌病 3例 ,无伴随心脏病的孤立心肌桥5 0例。孤立心肌桥中收缩期冠状动脉狭窄程度≥ 70 % 2 5例 ,5 0 %～ 70 % 17例 ,<5 0 % 8例。孤立心肌桥中有胸痛症状 2 5例 ;心电图提示有 ST- T改变 18例 ;行运动负荷试验阳性 18例。 69例心肌桥中超声心动图或左心室造影提示有室壁肥厚 13例。结论　冠状动脉造影是心肌桥的可靠检出手段。心肌桥可伴随其他心脏病发生也可孤立存在。心肌桥引起冠状动脉收缩期的高度狭窄而导致心肌缺血症状、心电图 ST- T变化、运动负荷试验阳性 ,狭窄程度越重 ,上述表现越显著     

动态心电图对无症状性心肌缺血的监测分析

目的探讨动态心电图对冠心病无症状性心肌缺血患者的临床诊断及其意义。方法对30例诊断明确的冠心病患者应用12导联24h动态心电图进行监测。结果 30例冠心病患者中,检测出心肌缺血者27例,其中无症状性心肌缺血ST改变占76%。结论动态心电图对无症状性心肌缺血的及时检出以及对治疗指导有较高的临床价值。     

有症状冠状动脉心肌桥的临床特点分析

目的分析冠状动脉心肌桥患者的临床特点及治疗。方法回顾性分析33例冠状动脉心肌桥患者的临床资料。结果33例患者中男性（26例）多于女性（7例）,平均年龄（52±11）岁,冠状动脉造影显示心肌桥多位于前降支中段。30例有不同程度的胸部不适症状（91%）,伴有高血压者13例（40%）,伴冠状动脉粥样硬化5例（15%）,伴有高脂血症者4例（12%）,伴有糖尿病者3例（9%）。26例患者应用药物治疗,5例患者行冠状动脉内支架植入术和肌桥松解术和（或）冠状动脉搭桥术后症状均明显缓解。共随访24例患者,平均随访（2.2±1.2）年。18例患者出院后继续药物治疗,随访期间无患者死亡。结论冠状动脉心肌桥患者多表现为典型与不典型心绞痛症状,通过药物、介入和手术可改善患者症状。心肌桥患者预后通常良好。     

Myocardial bridges: Overview of diagnosis and management

A myocardial bridge is a segment of a coronary artery that travels into the myocardium instead of the normal epicardial course. Although it is general perception that myocardial bridges are normal variants, patients with myocardial bridges can present with symptoms, such as exertional chest pain, that cannot be explained by a secondary etiology. Such patients may benefit from individualized medical/surgical therapy. This article describes the prevalence, clinical presentation, classification, evaluation, and management of children and adults with symptomatic myocardial bridges.