冠状动脉心肌桥造影特点及临床意义

目的　分析心肌桥在冠状动脉造影中的表现特征并探讨其临床意义。方法　对 870例选择性冠状动脉造影检出的冠状动脉心肌桥的患者临床资料进行回顾性分析。结果　 870例中共检出冠状动脉心肌桥 10例 ,发生率为 1.15 % ,其中 9例为左前降支心肌桥 ,1例在左回旋支 ,收缩期狭窄程度 >5 0 %的有 7例 ,均有心绞痛症状 ,心电图提示有 ST段下移及 T波改变等心肌缺血表现 ,2例合并冠状动脉粥样硬化性心脏病 ,1例合并有心室壁肥厚 ,6例为单纯性心肌桥。结论　冠状动脉造影中心肌桥的检出率较低 ,冠状动脉心肌桥的存在可能导致缺血性心脏病 ,引起心肌缺血及相应心电图改变 ,临床上对有症状的心肌桥患者应当给予积极治疗。     

心肌桥的冠状动脉造影特点及临床意义

目的 :探讨心肌桥的冠状动脉 (冠脉 )造影特点及其临床意义。方法 :对 747例接受选择性冠脉造影的病例进行回顾性分析 ,共检出心肌桥 3 8例 ,采用计算机辅助定量冠脉造影系统软件对心肌桥进行定量分析。结果 :3 8例均为前降支肌桥 ,在冠脉投照位中以左肩位及右肩位收缩期狭窄最严重 ,肌桥长度平均 18 8± 5 1mm ,肌桥近端距第一对角支距离平均 2 0 1± 7 6mm ,距前降支起始部距离平均 3 1 3± 9 7mm ,距左冠脉起始部距离平均45 1± 10 4mm。肌桥前有动脉硬化或狭窄表现者 11例 ( 2 9% ) ,合并冠脉瘘 3例 ( 8% ) ,合并肥厚性心肌病 2例 ( 5 % )。结论 :在冠脉造影中心肌桥现象并非罕见 ,左肩位造影发现率高 ,严重心肌桥可以造成心肌缺血。     

冠状动脉造影时心肌桥的检出率及其临床意义

目的探讨冠状动脉造影时心肌桥的检出率及其临床意义。方法2655例接受冠状动脉造影的患者,根据造影显示冠状动脉管腔收缩期狭窄程度判定心肌桥,并根据收缩期狭窄程度分为3级。结果共检出69例心肌桥,检出率2.6%,部位均位于左前降支。其中1级狭窄59例(85.5%),2级狭窄9例(13.0%),3级狭窄1例(1.4%)。21例(30.4%)在心肌桥近端有粥样硬化病变,28例(40.6%)有不同程度的心绞痛。1例95%收缩期狭窄病例置入冠脉内支架,其他病例经药物治疗,临床症状消失。结论冠状动脉造影时收缩期狭窄是临床判定心肌桥的唯一依据。心肌桥可导致缺血性心脏事件,对于有缺血症状者应予适当治疗。     

冠状动脉造影诊断心肌桥的临床分析

<正>本研究回顾性分析13例冠状动脉心肌桥患者的临床资料,结合其相关的心电图改变和冠脉造影特点,归纳心肌桥的临床特点。1资料和方法1.1一般资料:收集2009年7月到2012年3月行择期冠脉造影的381例患者,女132例,男249例。年龄25～90(62.78±11.52)岁。1.2方法:冠状动脉造影采用:Judkin法:对于左侧冠状动脉造影,采用了右前斜+足位、左前斜+足位、后前位+足位、后前位+头位、右前斜+头位、左前斜+头位6个不同的投影位置。对于右侧冠状动     

成人冠状动脉心肌桥造影分析

目前冠状动脉心肌桥与冠心病的关系受到学术界的广泛重视。本研究回顾性分析了大样本成年人群冠状动脉造影心肌桥发生特点及其临床意义。     

成人心肌桥的冠状动脉造影特点及临床意义

目的探讨心肌桥的冠状动脉造影特点及其临床意义。方法对1123例接受选择性冠状动脉造影的病例进行回顾性分析。共检出心肌桥57例,采用计算机辅助定量冠脉造影系统软件对心肌桥定量分析。结果57例中有56例为前降支肌桥,在冠脉造影投照位中以左肩位收缩期狭窄最严重,回旋支肌桥1例。肌桥长度平均18.2±5.1mm,肌桥前有动脉硬化或狭窄表现者15例。结论在冠状动脉造影中心肌桥并非罕见,左肩位造影发现率最高,严重心肌桥可以造成心肌缺血。     

壁冠状动脉心肌桥的造影和临床分析

目的:观察、分析壁冠状动脉(冠脉)和心肌桥的临床特点与诊断、治疗方法。方法:观察、分析经冠脉造影确诊的96例109处心肌桥患者的心肌桥分布特点、临床症状、心电图、心肌酶谱、肌钙蛋白T、心脏超声,评价药物或支架治疗心肌桥的疗效。结果:心电图、临床症状、心肌酶谱、肌钙蛋白T和心脏超声对心肌桥的诊断均无特异性。造影发现93.7%的心肌桥发生于冠脉前降支(LAD)。心肌桥患者临床症状与收缩期狭窄程度有关。药物治疗、手术治疗均有一定疗效。结论:冠脉造影发现"收缩期狭窄"为目前确诊心肌桥的主要方法。心肌桥与心绞痛、动脉粥样硬化、心肌梗死的发生有密切关系。药物治疗可选用肾上腺素β受体阻滞剂和Ca2+拮抗剂。     

冠状动脉造影检查对心肌桥的诊断价值

目的 探讨冠状动脉造影检查对心肌桥诊断的应用,研究心肌桥和冠状动脉粥样硬化的相关性.方法 收集1523例患者冠状动脉造影检查资料,分析心肌桥检出率,观察心肌桥的发生位置、壁冠状动脉收缩期狭窄程度、心肌桥血管合并粥样斑块的位置、斑块处管腔狭窄程度.结果 全部1523例患者中,201例患者检查结果正常,1225例患者检出粥样斑块,231例患者检出心肌桥.心肌桥检出率为15.2％,共检出心肌桥235处.心肌桥位置：右冠状动脉1处,左主干1处,旋支1处,对角支3处,左前降支229处,以左前降支中段多见,壁冠状动脉收缩期轻度狭窄为主.纯心肌桥97例.134例患者心肌桥血管合并粥样斑块144处,斑块位置：心肌桥近端111处,心肌桥段19处,心肌桥远端14处.心肌桥近端血管粥样硬化较心肌桥段、心肌桥远端发生率高,但粥样斑块的形成与壁冠状动脉收缩期的狭窄程度无显著相关（P＞0.05）.结论 心肌桥多见于左前降支中段血管,壁冠状动脉收缩期多为轻度狭窄,血管合并粥样硬化,多见于心肌桥前端,但粥样斑块的形成与壁冠状动脉收缩期狭窄程度无明显相关性.冠状动脉造影检查对心肌桥及心肌桥合并粥样硬化的诊断有重要价值.     

冠状动脉心肌桥及其临床意义

目的　探讨冠状动脉造影的病人中心肌桥的发生率及其临床意义。方法和结果　 2 557例行冠状动脉造影术的人群中 ,共检出心肌桥 1 7例 ,发生率为 0 665% ,均为左前降支心肌桥。收缩期狭窄程度 >50 %的有 1 4例 ,均有心绞痛症状 ,心电图提示有ST段移位、T波改变等心肌缺血表现 ;5例行心肌核素显像的病人提示有前壁心肌缺血。有 1例患者为陈旧前壁心肌梗塞 ,心肌桥于收缩期致 1 0 0 %血流阻断。 1 7例病人中有 3例左心室造影提示有室壁肥厚。结论　冠状动脉造影中的心肌桥现象并非罕见。心肌桥的存在可引起心肌缺血及相应的心电图、核素心肌显像缺血改变 ,严重的心肌桥压迫可引起心肌梗塞。     

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     

冠状动脉心肌桥的临床表现及超声特点

目的　探讨冠状动脉心肌桥的临床意义及超声特点。方法和结果　对 32 16例冠状动脉造影中检出的 4 7例心肌桥患者进行回顾性分析。其中合并冠状动脉粥样硬化者 13例 ,瓣膜病 1例 ,肥厚性心肌病 3例 ,孤立性心肌桥 30例。孤立性心肌桥者中约 4 0 %临床表现为心肌缺血。与非缺血组相比 ,心肌缺血组收缩期狭窄程度更重 [(6 7 6± 15 4 ) %vs (4 9 9± 2 1 8) % ],左室重量亦更大[(2 15 6± 4 2 2 )gvs (178 7± 5 1 0 )g],E A比小于 1,P值均 <0 0 5。结论　冠状动脉心肌桥可引起心肌缺血 ,临床表现的不同与收缩期狭窄程度、左室重量、左室舒张功能有关。     

冠状动脉心肌桥与心肌缺血研究进展

<正>冠状动脉心肌桥(简称心肌桥)是一种先天性的冠状动脉发育异常,在正常情况下冠状动脉及其分支走行于心脏表面的心外膜下组织中,当一段冠状动脉被心肌包绕,则被心肌纤维覆盖的冠状动脉段称为壁冠状动脉,而这段心肌纤维称为冠状动脉心肌桥。心肌桥曾被认为是先天性的良性变异,而近年来发现其发生率较高并且与心肌缺血相关,这引起学者们对心肌桥进一步深入研究的兴趣。     

35例心肌桥心电图的临床分析

目的探讨心肌桥的冠状动脉造影特点和心电图的变化。方法回顾性分析冠状动脉造影中35例心肌桥的临床表现及冠状动脉造影和心电图的特点。结果冠状动脉造影心肌桥的检出率为1％，均位于左前降支，其中1级狭窄5例，2级狭窄12例，3级狭窄18例，16例病人伴有冠状动脉粥样硬化样改变。金部病例均有临床症状，23例有心电图ST-T改变，运动试验阳性8例，可疑阳性5例，3例病人出现与相关心肌桥无关的下壁心肌梗死。16例病人随访0．5～3年，无1例发生与相关血管有关的急性心肌梗死、心源性猝死和急性心衰。结论冠状动脉心肌桥可能导致心肌缺血，引起心绞痛，但预后良好。     

冠状动脉心肌桥的临床特点与治疗

目的探讨冠状动脉心肌桥的冠脉造影特点、临床意义及治疗方法。方法回顾性分析293例冠状动脉造影中检出的8例心肌桥患者的临床资料。结果共检出心肌桥8例,均位于前降支,心肌桥发生率为2.7%,心肌桥长度8～25mm,平均14.5mm。依据Nobel分级法,Ⅰ级3例,Ⅱ级4例,Ⅲ级1例。1例Ⅲ级患者同时并发冠脉粥样硬化,病变位于回旋支中段,狭窄<50%。8例患者应用β受体阻滞剂或钙拮抗剂治疗后症状均明显缓解。结论选择性冠脉造影可用于心肌桥的诊断,心肌桥可能引起心肌缺血表现,应用β受体阻滞剂或钙拮抗剂等药物治疗有效。     

Myocardial bridging as one of the causes of atypical chest pain in young women

Introduction

Myocardial bridging is congenital anomaly which usually has benign prognosis but there are also reports suggesting that it can be associated with ischemic clinical syndromes presenting with chest pain. Coronary computed tomography angiography is a well-established method for detecting myocardial bridging. However, clinical significance of this anomaly still remains unclear.

心肌桥误诊临床观察——附17例报告

目的观察有症状心肌桥的临床特点,提高对心肌桥的认识,避免误诊或漏诊、延误治疗。方法收集386例冠状动脉造影中17例心肌桥病例,回顾性分析其临床特点和诊疗经过。结果本组冠脉造影病例心肌桥检出率为4.40%(17/386),诊断为心绞痛者13例,急性心肌梗死者1例,心脏瓣膜病2例,胸痛待查1例。冠脉造影证实心肌桥合并冠心病10例,心脏瓣膜病2例,漏诊率为70.59%,误诊为冠心病4例,误诊率23.53%。17例心肌桥患者中有8例硝酸酯类药物治疗效果不佳。结论心肌桥患者常在中年以后出现酷似CHD的临床特征及ECG表现,行冠状动脉造影可明确诊断。常规治疗效果不满意的患者,可考虑应用β受体阻滞剂或(和)钙离子拮抗剂治疗。     

Myocardial bridging analysis by coronary computed tomographic angiography in a Saudi population

AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography (CCTA).METHODS: A total of 350 CCTA of Saudi patients were included in this study (236 men, 114 women) with a mean age of 56.3 years. All patients were examined for appropriateness criteria of CCTA indications (typical chest pain, recent onset cardiomyopathy, left bundle branch block, etc.). The scans were retrospectively reviewed for the presence of myocardial bridging and any other pathological association.RESULTS: Myocardial bridging was found in 89 of 350 (22.5%) patients. Most of the intramuscular segments were of the superficial type and found in the mid left anterior descending (LAD) (24.6%), followed by distal LAD (3.7%), diagonal branches (2%), ramus intermedius artery (1.4%) and obtuse marginal artery (0.8%). No myocardial bridging was detected in the right coronary or circumflex arteries. No significant differences were found between males and females (P = 0.14). Coronary artery atherosclerosis was found in 51 of 89 (57.3%) patients with MB. Atherosclerotic plaques were not detected in the intramuscular or distal segment of bridging arteries. Dynamic compression was observed in 35 (94.5%) patients with full encasement. No evidence of myocardial hypoperfusion was found in the territories supplied by the bridging arteries.CONCLUSION: CCTA is excellent in analyzing myocardial bridging in a Saudi population and the results are comparable to other populations. However, finding the real incidence may need a large multicenter study.     

Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

We present a case of a 71-year-old male who had chest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year, and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia, he was admitted to our institution for coronary angiography (CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery (LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm, which was relieved after the intracoronary infusion of nitroglycerin. Finally, a CAG showed myocardial bridging (MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77, which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus, coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia.     

The chance finding at multislice computed tomography coronary angiography of myocardial bridging

Myocardial bridging is present when a segment of a major epicardial coronary artery, the ‘tunnelled artery’, runs intramurally through the myocardium. With each systole, the coronary artery is compressed. The pathophysiology of myocardial bridging is incompletely understood. With each systole, the coronary artery is compressed. Moreover, intravascular ultrasound analysis revealed a delayed relaxation after systolic compression, which may extend significantly into diastole. This explains both the impaired coronary flow reserve and ischemia. Evidence indicates that the intima beneath the bridge is protected from atherosclerosis, and the proximal segment is more susceptible to the development of atherosclerotic lesions because of haemodynamic disturbances. Myocardial bridging is sometimes associated with overt pathology, as well as it can just be an incidental finding without any significance. Myocardial bridging may cause angina pectoris, myocardial infarction, life threatening arrhythmias and even sudden cardiac death but most of them are harmless. Furthermore depressed left ventricular function, myocardial stunning, early death after cardiac transplantation has been also reported. Although the exact management is not well known, beta blockers seem to be the first choice. Stenting is controversial and one must think “twice” before stenting the bridged coronary artery. We report a case of chance finding at multislice computed tomography coronary angiography of two myocardial bridging. Also this case focuses attention on myocardial bridging and it confirms that multislice computed tomography coronary angiography technology represents a useful, noninvasive imaging method of its assessment.