汪雁博,郝国贞

• 1:河北医科大学第二医院心内五科

摘要(Abstract)：

心肌桥是一种先天性异常,是心外膜冠状动脉经过心肌内走行。依据检查方法不同,心肌桥的患病率报告存在一定差异。近年来的个案报道和研究结果显示,心肌桥可能与心肌梗死、心律失常和猝死的发生相关。本文通过回顾国内外相关的研究,认为心肌桥可对心脏功能造成不良影响,以心脏舒张功能不全为主,同时受患者性别和药物影响,采用新型超声检测方法有助于提高心功能评价的准确性。心肌桥导致的心功能不全与其导致的异常血流状态诱发的急慢性心肌缺血状态有关。根据患者的疾病状态和诊疗需要,合理选择不同的检查方法,能够准确评价心肌桥的程度和患者的心功能状态。不同治疗方案对心肌桥患者心脏功能的影响仍有待进一步观察研究。

关键词(KeyWords)： 心肌桥;心脏功能;影像学

Abstract:

Keywords:

基金项目(Foundation): 河北省2019年度医学科学研究课题(20190523)

作者(Author): 汪雁博,郝国贞

参考文献(References)：

• [1]Lee MS,Chen CH.Myocardial bridging:an up-to-date review.JInvasive Cardiol,2015,27(11):521-528.
• [2]Dursun I,Bahcivan M,Durna K,et al.Treatment strategies in myocardial bridging:a case report.Cardiovasc Revasc Med,2006,7(3):195-198.
• [3]Tauth J,Sullebarger T.Myocardial infarction associated with myocardial bridging:case history and review of the literature.Cathet Cardiovasc Diagn,1997,40(4):364-367.
• [4]Corban MT,Hung OY,Eshtehardi P,et al.Myocardial bridging:contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies.J Am Coll Cardiol,2014,63(22):2346-2355.
• [5]Dupont M,Mullens W,De Bruyne B,et al.Myotomy through heart-port access for myocardial bridging.Int J Cardiol,2008,124(1):e16-e18.
• [6]鲁明军，王玮，许玲玲，等.前降支单纯性心肌桥与左心结构及功能关系研究.中国实用医药，2013,8(19):7-8.
• [7]赵新斌，傅昱，李劼，等.心肌桥-壁冠状动脉对心功能的影响.中国医学科学院学报，2017,39(5):669-673.
• [8]Zhang M,Yang J,Ma C,et al.Longitudinal strain measured by two-dimensional speckle tracking echocardiography to evaluate left ventricular function in patients with myocardial bridging of the left anterior descending coronary artery.Echocardiography,2019,36(6):1066-1073.
• [9]Wang D,Sun JP,Lee AP,et al.Evaluation of left ventricular function by three-dimensional speckle-tracking echocardiography in pa tients wit h m yoca rdial bridging of t he lef t a nterior descending coronary artery.J Am Soc Echocardiogr,2015,28(6):674-682.
• [10]朱红伟.单纯心肌桥对冠状动脉造影正常成人心功能的影响.山东医药，2016,56(22):55-57.
• [11]Jhi JH,Cho KI,Ha JK,et al.Alteration of left ventricular function with dobutamine challenge in patients with myocardial bridge.Korean J Intern Med,2011,26(4):410-420.
• [12]Klues HG,Schwarz ER,vom Dahl J,et al.Disturbed intracoronary hemodynamics in myocardial bridging:early normalization by intracoronary stent placement.Circulation,1997,96(9):2905-2913.
• [13]Alegria JR,Herrmann J,Holmes DR Jr,et al.Myocardial bridging.Eur Heart J,2005,26(12):1159-1168.
• [14]Glagov S,Zarins C,Giddens DP,et al.Hemodynamics and atherosclerosis:insights and perspectives gained f rom studies of human arteries.Arch Pathol Lab Med,1988,112(10):1018-1031.
• [15]Gibson CM,Diaz L,Kandarpa K,et al.Relation of vessel wall shear stress to atherosclerosis progression in human coronary arteries.Arterioscler Thromb,1993,13(2):310-315.
• [16]Sawchuk AP,Unthank JL,Davis TE,et al.A prospective,in vivo study of the relationship between blood flow hemodynamics and atherosclerosis in a hyperlipidemic swine model.J Vasc Surg,1994,19(1):58-63.
• [17]Asakura T,Karino T.Flow patterns and spatial distribution of atherosclerotic lesions in human coronary arteries.Circ Res,1990,66(4):1045-1066.
• [18]Ge J,Jeremias A,Rupp A,et al.New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler.Eur Heart J,1999,20(23):1707-1716.
• [19]Masuda T,Ishikawa Y,Akasaka Y,et al.The effect of myocardial bridging of the coronary artery on vasoactive agents and atherosclerosis localization.J Pathol,2001,193(3):408-414.
• [20]Kuhn FE,Reagan K,Mohler ER,et al.Evidence for endothelial dysfunction and enhanced vasoconstriction in myocardial bridges.Am Heart J,1991,122(6):1764-1766.
• [21]Rozenberg VD,Nepomnyashchikh LM.Pathomorphology and pathogenic role of myocardial bridges in sudden cardiac death.Bull Exp Biol Med,2004,138(1):87-92.
• [22]Hostiuc S,Curca GC,Dermangiu D,et al.Morphological changes associated with hemodynamically significant myocardial bridges in sudden cardiac death.Thorac Cardiovasc Surg,2011,59(7):393-398.
• [23]黎瑞枫，梁立华.心肌桥影像学研究现状及进展.中国医药科学，2019,9(7):35-39.
• [24]朱红伟，王丽丽，李艳.自动和手动算法在评估心肌桥患者冠脉CTA检查心功能的比较.影像技术，2016,28(5):7-9.
• [25]钦建平，芦钺，郑义，等.核素心肌灌注显像与超声心动图对心肌桥患者心肌缺血评估的对比研究.中国医学装备，2016,13(2):67-70.
• [26]王新贤，黄朴忠，徐升，等.应用经胸冠脉超声诊断心肌桥的初探.中国超声医学杂志，2019,35(2):122-124.
• [27]Schwarz ER,Klues HG,vom Dahl J,et al.Functional,angiographic,and intracoronary Doppler flow characteristics in symptomatic patients with myocardial bridging:effect of short-term intravenous beta-blocker medication.J Am Coll Cardiol,1996,27(7):1637-1645.
• [28]Ishimori T,Raizner AE,Chahine RA,et al.Myocardial bridges in man:clinical correlations and angiographic accentuation with nitroglycerin.Cathet Cardiovasc Diagn,1977,3(1):59-65.
• [29]Hongo Y,Tada H,Ito K,et al.Augmentation of vessel squeezing at coronary-myocardial bridge by nitroglycerin:study by quantitative coronary angiography and intravascular ultrasound.Am Heart J,1999,138(2 Pt 1):345-350.
• [30]Stables RH,Knight CJ,Mc Neill JG,et al.Coronary stenting in the management of myocardial ischaemia caused by muscle bridging.Br Heart J,1995,74(1):90-92.
• [31]Ishii T,Asuwa N,Masuda S,et al.The eff ects of a myocardial bridge on coronary atherosclerosis and ischemia.J Pathol,1998,185(1):4-9.
• [32]Tsujita K,Maehara A,Mintz GS,et al.Impact of myocardial bridge on clinical outcome after coronary stent placement.Am JCardiol,2009,103(10):1344-1348.
• [33]Srinivasan M,Prasad A.Metal fatigue in myocardial bridges:stent fracture limits the efficacy of drug-eluting stents.J Invasive Cardiol,2011,23(6):E150-E152.
• [34]Hill RC,Chitwood WR Jr,Bashore TM,et al.Coronary flow and regional function before and af ter supraarterial myotomy for myocardial bridging.Ann Thorac Surg,1981,31(2):176-181.
• [35]Iversen S,Hake U,Mayer E,et al.Surgical treatment of myocardial bridging causing coronary artery obstruction.Scand JThorac Cardiovasc Surg,1992,26(2):107-111.
• [36]Attaran S,Moscarelli M,Athanasiou T,et al.Is coronary artery bypass graf ting an acceptable alternative to myotomy for the treatment of myocardial bridging?Interact Cardiovasc Thorac Surg,2013,16(3):347-349.