Baryalei Mersa M, Tirilomis Theodorus, Buhre Wolfgang, Kazmaier Stephan, Schoendube Friedrich A, Aleksic Ivan
Department of Thoracic and Cardiovascular Surgery, Georg-August-University Göttingen, Germany.
Heart Surg Forum. 2005;8(1):E49-54; discussion E49-54. doi: 10.1532/HSF98.20041116.
Myocardial bridging of the left anterior descending (LAD) artery may result in clinical symptoms. Surgery with cardiopulmonary bypass (CPB) is a therapeutic option with considerable risk. We hypothesized that off-pump supraarterial myotomy could be an effective treatment modality.
Between October 1998 and May 2000, 13 patients were referred for surgery. All were symptomatic despite medical therapy. Anteroseptal ischemia had been proven by thallium scintigraphy in all 13 patients, exercise testing was positive in 11. All patients were operated on with an off-pump approach after median sternotomy.
Mean patient age was 61 +/- 8 years (range, 43-71 years). Coronary artery disease mandating additional bypasses was present in 3 patients. The bypasses were done off pump in 2 patients. Conversion to on-pump surgery was necessary in 3 of 13 patients (23%) because of hemodynamic compromise (1 patient), opening of the right ventricle (1 patient), and injury to the LAD (1 patient). Supraarterial myotomy was performed in all patients. One patient who underwent surgery with CPB developed postoperative anteroseptal myocardial infarction. Postoperative exercise testing was performed in all patients and did not reveal any persistent ischemia. Mortality was 0%. All patients were free from symptoms and had not undergone repeat interventions after an average of 51 +/- 7 months of follow-up.
Off-pump supraarterial myotomy effectively relieves coronary obstruction but has a certain periprocedural risk as evidenced by 1 myocardial infarction, 1 right ventricular injury, and 1 LAD injury. Long-term freedom from symptoms and from reintervention favor further investigation of this surgical therapy.
左前降支（LAD）动脉心肌桥可能导致临床症状。体外循环（CPB）手术是一种风险较高的治疗选择。我们推测非体外循环下动脉上心肌切开术可能是一种有效的治疗方式。
1998年10月至2000年5月期间，13例患者被转诊接受手术。尽管接受了药物治疗，但所有患者均有症状。所有13例患者经铊闪烁扫描证实存在前间隔缺血，11例运动试验呈阳性。所有患者均在正中胸骨切开术后采用非体外循环方法进行手术。
患者平均年龄为61±8岁（范围43 - 71岁）。3例患者存在需要额外搭桥的冠状动脉疾病。2例患者在非体外循环下进行了搭桥手术。13例患者中有3例（23%）因血流动力学不稳定（1例）、右心室开放（1例）和LAD损伤（1例）而需要转为体外循环手术。所有患者均进行了动脉上心肌切开术。1例接受CPB手术的患者发生了术后前间隔心肌梗死。所有患者均进行了术后运动试验，未发现任何持续性缺血。死亡率为0%。所有患者均无症状，平均随访51±7个月后未进行再次干预。
非体外循环下动脉上心肌切开术可有效缓解冠状动脉梗阻，但有一定的围手术期风险，表现为1例心肌梗死、1例右心室损伤和1例LAD损伤。长期无症状和无需再次干预支持对这种手术治疗进行进一步研究。
