肥厚型心肌病冠状动脉肌桥造影特点分析

Characteristics of Coronary Angiogram in Hypertrophic Cardiomyopathy and Myocardial Bridging

目的 :分析在肥厚型心肌病患者冠状动脉 (冠脉 )肌桥的临床及造影特点。 方法 :肥厚型心肌病患者 90例 ,所有患者通过采用Judkins法接受选择性冠脉造影及左心室造影检查 ,每支冠脉均经多体位投照 ,以收缩期冠脉管腔直径压缩至少 5 0 %或出现吸吮效应作为确定肌桥存在的证据 ,同时以至少一支冠脉管腔狭窄≥ 5 0 %作为有意义狭窄。 结果 :90例患者中发现肌桥 19例 (2 1 1% ) ,其造影特点显示 ①按压缩部位分类 :前降支中段 14例 (74% ) ,前降支中远段 1例 (5 % ) ,前降支弥漫性压缩 1例 (5 % ) ,间隔支 2例 (11% ) ,前降支中远段加对角支 1例 (5 % ) ;②按压缩程度分类 :收缩期管腔直径压缩 <5 0 %者 4例 (2 1% ) ,≥ 5 0 %～≤ 80 %者 11例 (5 8% ) ,>80 %～≤ 90 %者 2例(11% ) ,>90 %～ 10 0 %者 2例 (11% ) ;③左心室造影显示异常者 13例 (68% ) ,正常者 6例 (3 2 % )。此外经造影证实合并冠心病者 2例 (11% )。 结论 :在肥厚型心肌病中肌桥为常见征象 ,明显高于其他患者 ,故临床应予以重视。

Objective: To analyse the clinical and coronary angiographic characteristics of hypertrophic cardiomyopathy complicated by myocardial bridging. Methods: The coronary angiograms of 90 patients with hypertrophic cardiomyopathy (HC), studied at Fu Wai Hospital were reviewed. Patients underwent selective coronary angiography and left ventriculography by use of the Judkins technique. Multiple views of each coronary artery were filmed. A≥50% of systolic narrowing or “ milking effect” was defined as myocardial bridging. Coronary angiography confirmed the presence of a myocardial bridge in 19 patients(21.1%). A≥50% of stenosis of at least one vessel was considered affected by critical coronary artery disease. Statistical analysis was performed using SAS software methods for small samples. Results:①The parts of compressed vessels: the middle segment of left anterior descending (LAD) in 14 cases (74%), the distal segment of LAD in 1(5%), diffusion compression in 1(5%), septal perforator in 2(11%), the distal segment of LAD and diagonal branch in 1(5%);②The degrees of compressed systolic narrowing: ≤50% in 4 (21%), >50-≤80% in 11(58%), >80%-≤90% in 2 (11%),>90%-100% in 2 (11%); ③Left ventriculography revealed the presence of left ventricular abnormality in 13 (68%) , the other 6 cases was normal (32%). Coronary angiography demonstrated coexistent coronary artery disease in 2. Conclusion: Myocardial bridging is a common phenomenon for hypertrophic cardiomyopathy. The association of myocardial bridging with hypertrophic cardiomyopathy should be borne in mind because of its evidently higher than those of other patients.