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

Clinical analysis of 69 cases of coronary myocardial bridge

Objective To assess the prevalence of coronary myocardial bridge in patients underwent diagnostic angiography and its clinical features.Methods and Results Among 1 678 coronary angiograms performed in the Wuhan Asia Heart Hospital, 69 patients had myocardial bridge over the left anterior descending arteries.The total prevalence of myocardial bridges was 4.11%. Among these patients, 13 had coronary artery disease, 3 had valvular heart disease and 3 had cardiomyopathy. 50 had isolated myocardial bridges. Among the patients with isolated myocardial bridge, 25 had >70% systolic narrowing of coronary artery,17 had 50%～70%,8 had <50% .Among 50 patients with isolated myocardial bridges,25 had chest pain and 18 had ST-T abnormality in electrocardiogram.13 patients were showed myocardial hypertrophy by left ventriculogram or echocardiogram.Conclusions Myocardial bridge could be found by Coronary angiography. The prevalence of coronary myocardial bridging in the studied coronary angiographic population was 4.11%. Myocardial bridge could be responsible for symptoms of myocardial ischemia, ST-T abnormality in electrocardiogram and positive result in exercise testing. The symptoms were associated with the degree of narrowing of the left anterior descending artery during systole.