Cardiology Department, Memorial Bahcelievler Hospital, Istanbul, Turkey.
Echocardiography Laboratory, 2nd Cardiology Department, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
BMC Cardiovasc Disord. 2021 Nov 20;21(1):557. doi: 10.1186/s12872-021-02341-7.
Myocardial crypts are discrete, narrow, blood filled invaginations within the left ventricular myocardium and high-take-off coronary artery are rare manifestations where coronary arteries originate above the sinotubuler junction.
A 41-year-old man with multiple coronary artery disease risk factors admitted to our outpatient department with progressive dyspnea and atypical chest pain. Physical examination revealed no pathological findings. His blood examination revealed only mild to moderately high IgE and LDL levels. Transthoracic echocardiography (TTE) was normal. His treadmill test was normal, yet in the 3rd stage of the test he had an atypically located chest pain which was relieved in the resting period. As he had multiple cardiovascular risk factors, we performed a coronary CT angiography to exclude coronary artery disease. Coronary CT angiography(CCTA) demonstrated multiple myocardial crypts, a muscular VSD like defect which were not detectable with TTE and a high take off left main coronary artery (LMCA). After CCTA, we repeated the TTE to investigate the crypts and VSD-like defect which were clear on CCTA, yet a precise TTE hardly showed crypts and didn't confirm a shunt between the left and right ventricle. We defined the defect as 'spontaneously closed muscular VSD'. None of these pathologies were clinically relevant with the patient's symptoms, thus pneumonology started a montelukast therapy for 1 year and we decided to follow up the patient, as multiple crypts may indicate an early phase hypertrophic cardiomyopathy.
Considering that a high take-off LMCA is a congenital anomaly, encountering multiple crypts which are also congenital pathologies, is plausible, as congenital anomalies may accompany eachother. Echocardiography is a very useful, practical imaging tool but regrettably may be suboptimal due to various patient and method related reasons. Target combination of different cardiovascular imaging tools like echocardiography, cardiac CT(CCT), may be utilized in order to ensure a comprehensive diagnosis particularly.
心肌隐窝是左心室心肌内的离散、狭窄、充满血液的内陷，而高起点冠状动脉是冠状动脉起源于窦管交界处上方的罕见表现。
一名 41 岁男性，有多种冠状动脉疾病危险因素，因进行性呼吸困难和非典型胸痛就诊于我院门诊。体格检查无病理发现。血液检查仅显示 IgE 和 LDL 水平轻度至中度升高。经胸超声心动图（TTE）正常。他的跑步机测试正常，但在测试的第 3 阶段，他出现了位置不典型的胸痛，在休息期间缓解。由于他有多种心血管危险因素，我们进行了冠状动脉 CT 血管造影以排除冠状动脉疾病。冠状动脉 CT 血管造影（CCTA）显示多个心肌隐窝、TTE 无法检测到的类似肌性室间隔缺损（VSD）和高起点左主干冠状动脉（LMCA）。在 CCTA 后，我们重复 TTE 以研究隐窝和 CCTA 上清楚显示的类似 VSD 缺陷，但精确的 TTE 几乎无法显示隐窝，也无法确认左、右心室之间的分流。我们将该缺陷定义为“自发性闭合的肌性 VSD”。这些病变均与患者的症状无关，因此呼吸科开始为患者进行孟鲁司特治疗 1 年，我们决定对患者进行随访，因为多发性隐窝可能提示早期肥厚型心肌病。
考虑到高起点 LMCA 是一种先天性异常，遇到也是先天性病变的多个隐窝是合理的，因为先天性异常可能同时存在。超声心动图是一种非常有用、实用的成像工具，但由于各种患者和方法相关的原因，可能效果不佳。不同心血管成像工具（如超声心动图、心脏 CT（CCT））的靶向组合可能被用于确保全面诊断，特别是。
