Hu Yuecheng, Cong Hongliang, Zheng Liuying, Jin Dongxia
Department of Cardiology, Tianjin Chest Hospital, Tianjin University, Chest Clinical Medical College of Tianjin Medical University, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China.
J Cardiothorac Surg. 2021 Nov 21;16(1):336. doi: 10.1186/s13019-021-01720-7.
It is difficult to choose correctly interventional strategy for coronary intermediate lesions combined with myocardial bridge. Endovascular imaging is advocated to guide treatment, but flow reserve fraction (FFR) is not recommended to guide the interventional treatment of myocardial bridge disease because of the inaccurate judgment misled by myocardial bridge.
In this study, we reported a case of a 56-year-old male patient with unstable angina pectoris (UAP). From his coronary angiography, we found diffuse stenosis near the midsection of the left anterior descending (LAD) branch and the presence of a severe myocardial bridge in the lesion area. We were sure that the LAD was culprit vessel and this lesion was culprit lesion. Both FFR and intravenous ultrasound (IVUS) were performed and the conclusions of them are different. Although stent implantation is not usually recommended in the myocardial bridge area. However, after careful examination, a stent was finally implanted under the precise guidance of FFR. And the patient recovered well up-to now.
This case illustrates that FFR functional test was complimentary to intravascular imaging test for the coronary intermediate lesion, especially the lesion wrapped with myocardial bridges, both in assessing the lesion and in guiding treatment.
对于合并心肌桥的冠状动脉中度病变，正确选择介入策略具有一定难度。目前提倡采用血管内成像来指导治疗，但由于心肌桥会导致判断不准确，不推荐使用血流储备分数（FFR）来指导心肌桥疾病的介入治疗。
在本研究中，我们报告了一例56岁男性不稳定型心绞痛（UAP）患者。通过冠状动脉造影，我们发现左前降支（LAD）中段附近存在弥漫性狭窄，且病变区域存在严重心肌桥。我们确定LAD为罪犯血管，该病变为罪犯病变。同时进行了FFR和血管内超声（IVUS）检查，二者结论不同。尽管通常不建议在心肌桥区域植入支架。然而，经过仔细检查，最终在FFR的精确引导下植入了支架。目前患者恢复良好。
该病例表明，对于冠状动脉中度病变，尤其是被心肌桥包裹的病变，FFR功能测试在评估病变和指导治疗方面，可作为血管内成像检查的补充。
