冠状动脉心肌桥165例冠脉造影特点和临床分析

Coronary angiographic features and clinical characteristics of 165 cases of coronary myocardial bridge

目的探讨冠状动脉心肌桥的冠脉造影特点及临床意义。方法回顾性分析经冠脉造影检出的165例心肌桥患者的临床资料、冠脉造影特点及治疗体会。结果心肌桥在冠脉造影中的检出率为12.0%,其中有139例(84.2%)心肌桥发生于前降支中段;102例孤立性心肌桥患者中有临床症状40例(Noble 1级7例,Noble 2级14例,Noble 3级19例),有心电图ST-T异常的5例(Noble 2级1例,Noble 3级4例);163例左前降支心肌桥患者中合并冠状动脉粥样硬化62例,其中发生于心肌桥近端54例(87.0%);所有存在临床症状的患者中均给予β受体阻滞剂和/或非二氢吡啶类钙拮抗剂应用,心肌桥近端严重狭窄(8例)予以冠脉介入治疗,效果均较好。结论冠状动脉心肌桥多发生于左前降支,其临床症状与Noble分级相关。β受体阻滞剂和/或非二氢吡啶类钙拮抗剂治疗有症状的心肌桥患者效果较好。冠脉动脉粥样硬化多发生于心肌桥近端血管,严重者可予以介入治疗。

Objective To explore the angiographic characteristics and clinical significance of coronary myocardial bridge.Methods The clinical data,coronary arterioangiographic findings and managements were analyzed retrospectively in 165 patients with myocardial bridge.Results The detection rate of myocardial bridge by coronal artery angiography amounted to 12.0%.The myocardial bridge located at the middle segment of left anterior descending artery（LAD） in 139 cases（84.2%）.Among 102 cases with isolated myocardial bridge,40 patients showed clinical symptoms（7 cases in Noble 1,14 cases in Noble 2,19 cases in Noble 3）,and 5 patients showed abnormal ST-T change on electrocardiogram（1 case in Noble 2,4 cases in Noble 3）.Among 163 cases with LAD myocardial bridge,62 patients had coronary atherosclerosis,and the atherosclerotic leision mainly located at segment proximal to the myocardial bridge（54 cases,87.0%）.All symptomatic patients were treated with β-receptor blocker or non-dihydropyridine calcium antagonist,and 8 cases with severe fixed stenosis proximal to the myocardial bridge were received coronary interventional therapy.Conclusion coronary myocardial bridge is usually located at LAD,and its clinical symptoms are related to the levels of Noble.β-receptor blockers or non-dihydropyridines can relieve symptom effectively.Atherosclerosis is often found at the coronary segments proximal to the myocardial bridge,and interventional therapy could be adopted in patients with severe fixed stenosis.