冠状动脉心肌桥合并其他心脏病外科治疗和随访观察

Surgical Outcome and Clinical Follow-up in Myocardial Bridging Patients Associated With Other Cardiovascular Diseases

目的：冠状动脉心肌桥在心脏收缩时受压迫可能引起心肌缺血。本文目的在于探讨心肌桥合并其他心脏病进行外科手术的治疗效果及术后中、远期随访观察。方法：1999年1月至2006年12月24例心肌桥合并其他心脏病患者在我院行心肌切开术和（或）冠状动脉旁路移植术（CABG），合并其他心脏病同期手术。所有患者均在全麻体外循环下完成手术，其中行心肌切开术11例，同时行二尖瓣成形2例、二尖瓣置换2例、主动脉瓣置换1例、双瓣置换并三尖瓣成形2例、CABG术3例及房间隔修补1例；心肌桥行CABG术13例，同时行二尖瓣置换3例、二尖瓣成形2例、主动脉瓣置换2例、双瓣置换并三尖瓣成形2例、左心室流出道疏通3例、升主动脉替换1例。结果：手术成功率100％，没有医院内死亡，所有患者均康复出院。1例二尖瓣置换和心肌切开术后2小时，急性前壁心肌梗死行CABG术，顺利恢复。在行CABG术的13例病例中，除1例外，其他均采用左侧乳内动脉与前降支吻合。2例失访，随访率92％，平均随访时间38个月（6～87个月）。16例患者无任何不适，另外6例偶有心悸、胸闷、气短等，症状较手术前明显好转。所有随访患者均无胸痛发作。患者心功能明显改善，心功能I级15例、Ⅱ级7例。所有22例患者在随访中未发生心肌梗死、死亡或需再次血运重建。结论：心肌桥合并其他需要手术治疗心脏病者，肌桥在收缩期狭窄大于50％，可能导致心肌缺血时，应同期手术治疗。外科手术能有效改善心肌桥引起的心肌缺血，手术风险小，中、远期疗效满意。

Objective ： Myocardial bridging with systolic compression of coronary artery may be associated with myocardial ischemia. The aim of the study was to assess the middle-and long-term results of surgical treatment for symptomatic myocardial bridging. Methods：From 1999-2006,24 patients with myocardial bridging and other cardiovascular diseases received myotomy and/or coronary artery bypass grafting （CABG） in the Fu Wai Cardiovascular Hospital. All of the patients were operated on by median sternotomy, with cardiopulmonary bypass. Among the patients, 11 underwent myotomy for treatment of myocardial bridging, concomitant mitral valve plasty （ n = 2 ） and mitral valve replacement （ n = 2）, aortic valve replacement （ n= 1 ）, double valve replacement with tricuspid plasty （n=2）, CABG（ n=3） and atrial septal defect repair （n=1 ）;The other 13 underwent CABG, concomitant mitral valve replacement （n=3 ）, mitral valve plasty （ n=2）, aortic valve replacement （ n=2 ）, double valve replacement with tricuspid plasty （n = 2）, septal myectomy （ n = 3 ） due to hypertrophic obstruction cardiomyopathy and ascending aorta replacement （n = 1 ）. Results ：The acute clinical success rate was 100% with no death or other major in-hospital complications. All patients survived the operation and recovered uneventfully. Among the 13 patients undergoing CABG, the left internal mammary artery was used in 12. Conversion to CABG surgery was necessary in 1 patient with myotomy and mitral valve replacement because of acute myocardial itffarction of the anterior wall. Twenty-two patients were followed up clinically with the follow-up rate of 92%. Themedian follow-up was 38 months （range ：6-87 months）. Sixteen patients were free from symptoms. The other 6 had symptoms of palpitation and shortness of breath which were much improved compared with preoperation. During follow-up, no patient had chest pain. None of the patients sustained a myocardial infarction or other major adverse cardiac events （ death or vessel revascularization） during follow-up. Conclusion：Surgical myotomy or CABG should be performed in myocardial bridging patients associated with other cardiac diseases requiring surgical treatment. Surgical relief of myocardia! ischemia due to systolic compression of intramyocardial coro- nary arteries can be accomplished with low operative risk and excellent middle-and long-term results.