冠状动脉旁路移植术治疗心肌桥临床分析

Clinical analysis of treatment of myocardial bridge by coronary artery bypass grafting

目的回顾性分析接受冠状动脉旁路移植术(CABG)心肌桥患者的临床特征和治疗效果。方法收集1999年3月—2009年3月收治的心肌桥患者的住院病史及随访资料。回顾患者的症状、检查、诊断、治疗和病情随访情况,分析总结临床特征和疗效,并结合文献复习进行相关讨论。结果共收治心肌桥患者26例,均经冠状动脉造影确诊或证实。患者均有心绞痛等心肌缺血症状而经药物治疗无明显改善;心电图主要表现为ST段压低,T波低平或倒置。所有患者接受CABG治疗,其中非体外循环下CABG(OPCABG)15例,体外循环下CABG(CCABG)11例;无手术死亡和相关并发症发生病例。术后随访(3.5±2.0)年,患者心肌缺血症状改善明显;发生心绞痛5例,经药物治疗后均缓解;心电图复查显示,22例ST段无明显异常,4例ST段压低较术前明显好转。结论心肌桥为先天性冠状动脉走行畸形,其诊断主要依靠冠状动脉造影。对心肌缺血症状严重而经药物治疗后无明显改善的心肌桥患者,CABG具有良好的治疗效果。部分患者术后仍有心绞痛发作,可能与血管痉挛以及自身血管与桥血管竞争血流有关。

Objective To analyse the clinical features and outcomes of myocardial bridge treated by coronary artery bypass grafting（CABG）. Methods The hospitalization and follow-up data of patients with myocardial bridge treated between March 1999 and March 2009 were collected.The symptoms,examinations,diagnosis,treatment and follow-up findings were retrospectively analysed,the clinical features and outcomes were analysed,and discussion was performed after literature review. Results Twenty-six patients with myocardial bridge were hospitalized,all of whom were confirmed by coronary angiography.All patients experienced symptoms of myocardial ischemia such as angina,which could not be relieved by medication.Electrocardiography was characterized by depressed ST,flat or inversed T wave.All patients received CABG（off-pump operation in 15 patients and on-pump operation in 11 patients）.No surgery-related death or complications occurred.Patients were followed up for（3.5±2.0） years,and symptom of myocardial ischemia was relieved in all.Angina took place in 5 patients,and was eased by medication.Electrocardiographic reexaminations revealed that ST was normal in 22 patients,and flat ST was improved in the other 4 patients after operation. Conclusion Myocardial bridge is one of the congenital coronary artery malformations,and was mainly diagnosed through coronary arteriography examination.CABG is one of the best choices for the treatment of myocardial bridge with severe myocardial ischemia.Angina after operation in some patients may be related to the vascular spasm,as well as the blood flow competition between own vessels and grafts.