冠脉内超声诊断冠脉造影固定性狭窄的心肌桥1例并文献复习

Diagnosis of Myocardial Bridge in Coronary Angiography Fixed Stenosis by Intracoronary Ultrasound: A Case Report and Literature Review

心肌桥(myocardial bridge, MB)的形成是由于冠状动脉走行于心肌之间的一种先天性解剖变异。资料显示,心肌桥在尸检病例中检出率高达40%~80%,但冠脉造影发现率仅为0.5%~12%。近年来随着冠脉内超声(IVUS)的发展,对于心肌桥的诊断准确率大大提升。本文报导一例因“发作性胸闷、胸痛1年,加重2天”疑诊“冠心病、不稳定性心绞痛”患者行冠脉造影,可见前降支中段固定性狭窄,管腔内径不随心动周期发生明显变化,并且与投照体位无关,随后行IVUS检查时,发现为典型的心肌桥改变,并及时调整治疗方案为例,提高对冠脉造影下表现为固定性狭窄性病变的诊治思路以及强调IVUS在介入领域的独特优势,指导治疗。

Myocardial bridge (MB) is a congenital anatomical variation of coronary artery which runs along the myocardium. The data showed that the detection rate of myocardial bridge in autopsy cases was as high as 40%~80%, but the detection rate of coronary angiography was only 0.5%~12%. In recent years, with the development of intracoronary ultrasound (IVUS), the diagnostic accuracy of myocardial bridge has been greatly improved. This paper reports a patient who suspected of “coronary heart disease and unstable angina pectoris” due to “paroxysmal chest tightness and chest pain for 1 year and aggravated for 2 days”. Coronary angiography showed fixed stenosis of the anterior descending artery. The lumen diameter did not change significantly in cardiac cycle, and had nothing to do with the projection position. Later, we used IVUS for further examination and we found that it is typical myocardial bridge and timely adjusted the treatment. We aim to improve the diagnosis and treatment of fixed stenotic lesions under coronary angiography, emphasize the unique advantages of IVUS in the field of intervention, and guide the treatment.