Michels R, Brueren G, van Dantzig J-M, Pijls N, Peels C H, Post H
Neth Heart J. 2005 Feb;13(2):57-61.
Isolated systolic compression of the mid portion of the left anterior descending artery (LAD) by a bridge of overlying cardiac muscle is an infrequent but well-recognised angiographic anomaly that is often considered harmless. The long-term prognosis appears to be excellent, but occasional reports of patients with angina pectoris, myocardial infarction and sudden death indicate that this is not always true. The prevalence of the anomaly in the normal population is unknown, but the incidence is low and ischaemic events are rare. Tako-tsubo-like left ventricular dysfunction syndrome (TTS) is characterised by ischaemia, anterior ST-segment elevation, no significant coronary artery disease and reversible ampulla-like left ventricular ballooning in postmenopausal females after emotional or physical stress. Dynamic left ventricular outflow tract (LVOT) obstruction is a rare but potentially fatal complication of acute anterior wall infarction. We present a patient with an acute coronary syndrome (ACS) with ST-segment elevation in the anterior leads, transient TTS and transient LVOT obstruction with systolic anterior motion (SAM) of the mitral valve and severe mitral regurgitation. This is the first report of myocardial bridging associated with TTS, and the first report of TTS associated with dynamic LVOT obstruction with SAM and mitral regurgitation.
左前降支（LAD）中段被覆盖其上的心肌桥孤立性收缩期压迫是一种罕见但已被充分认识的血管造影异常，通常被认为无害。其长期预后似乎极佳，但偶尔有关于心绞痛、心肌梗死和猝死患者的报道表明情况并非总是如此。该异常在正常人群中的患病率未知，但发病率较低且缺血事件罕见。应激性心肌病样左心室功能障碍综合征（TTS）的特征是缺血、前壁ST段抬高、无明显冠状动脉疾病以及绝经后女性在情绪或身体应激后出现可逆的壶腹样左心室扩张。动态左心室流出道（LVOT）梗阻是急性前壁心肌梗死罕见但可能致命的并发症。我们报告一例急性冠状动脉综合征（ACS）患者，其前壁导联ST段抬高、短暂性TTS以及伴有二尖瓣收缩期前向运动（SAM）和严重二尖瓣反流的短暂性LVOT梗阻。这是心肌桥与TTS相关的首例报告，也是TTS与伴有SAM和二尖瓣反流的动态LVOT梗阻相关的首例报告。
