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頁籤選單縮合
題名 | Myocardial Bridging=心肌架橋 |
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作者 | 陳吉賢; 林俊龍; | 書刊名 | 慈濟醫學 |
卷期 | 15:6 2003.12[民92.12] |
頁次 | 頁357-362 |
分類號 | 415.31 |
關鍵詞 | 心肌架橋; 冠狀動脈痙攣; 冠狀動脈粥狀硬化; 心肌缺血; Myocardial bridge; Coronary spasm; Coronary atherosclerosis; Myocardial ischemia; |
語文 | 英文(English) |
中文摘要 | 心肌架橋在常規心導管或心臟之病理解剖中並不少見。它是一種先天性異常,通常位於冠狀動脈左前降枝的中段。本病可見於解剖個案的5%-86%,但在心導管統計報告只有0.5%-12%。本症的深入型可見左前降枝彎曲及舒張期血流受到影響。臨床表徵包括非典型胸痛、異常心電圖變化、跑步機試驗陽性、持續性心室頻脈、束枝傳導阻滯、陣發性房室阻斷、鉈-心肌掃描可見可逆性心肌灌流不足等等。曾有報告指出個別個案出現急性心肌梗塞及其併發症,例如腦梗塞、心室血管瘤及心室中隔破裂。也曾有人指出心日性休克及猝死與心肌架橋有關。心肌架橋處的血整賽內膜常可免於粥狀硬化。因此處血管收縮導致的血行動力改變,大幅地影響粥狀硬化的形成及內膜魯質浸潤的調控。大部分此類病患都可經由適宜的抗心絞痛用藥得到症狀上的緩解。只有少數嚴重的病人才需要安排導管、血管整形、支架置入、外科切除或冠狀動脈繞道手術。 |
英文摘要 | Myocardial bridge is not an uncommon finding in routine diagnostic coronary angiography or pathological examination of the heart. It is a congenital anomaly, usually located over the mid portion of the left anterior descending coronary artery. It is found in 5%-86% in anatomic studies but only observed in 0.5%-12% of patient undergoing coronary autobiography. The deep type of MB crosses the left anterior descending coronary artery and can twist the coronary artery and compromise its diastolic flow. Clinical manifestations include atypical chest pain, and abnormal resting EKG, a positive treadmill test, sustained ventricular tachycardia, bundle blockage, paroxysmal atrioventricular block, reversible perfusion defect noted no hallium scan, etc. Isolated cases of acute myocardial infarction, and its complications, such as cerebral emboliation, ventricular aneurysm, and ventricular septal rupture, have been reported. Cardiogenic shock and sudden death have also been attributed toi myocardial bridging. The intima of the bridged been reported. Cardiogenic shock and sudden death have also been attributed to myocardialk bridging. The intima of the bridged arterial segment is generally spared from atherosclerosis. The alteration of hemolodynamic factors that arise from contraction of the myocardial bridge greatly affects the evolution of atherosclerosis through the regulation of intimal lipid infiltration within the myocardial bridge greatly affects have evolution of atherosclerosis through the regulation of intimal lipid infiltration within the artery. Symptomatic management with antianginal agents should be adequate in most cases. Percutaneous transluminal coronary angioplasty (PTCA), stenting, surgical resection of the bridge, and coronary bypass surgery are only reserved for the rare patient with severed symptoms. |
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