Department of cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France; Department of cardiology, Intercommunal Hospital Centre Castres-Mazamet, Castres, France; Faculty of medicine, Holy Spirit University of Kaslik, Jounieh, Lebanon.
Department of cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France.
Trends Cardiovasc Med. 2024 Jan;34(1):10-15. doi: 10.1016/j.tcm.2022.06.002. Epub 2022 Jun 10.
Myocardial bridging (MB) is a common congenital abnormality that remains asymptomatic in a large proportion of patients. The peak of clinical manifestation occurs during the third and fourth decades of life. MB provokes myocardial ischemia through different mechanisms including supply-demand mismatch, endothelial dysfunction, coronary microvascular dysfunction and external mechanical compression. The association between MB and atherosclerotic disease is controversial. Recent studies established a significant association of MB with myocardial infarction and non-obstructive coronary artery disease. The first line medical treatment is based on beta-blockers and calcium channel blockers. Ivabradine is used in second line therapy. Invasive approaches involving percutaneous coronary intervention, coronary artery bypass graft and myotomy are performed in patients with symptoms refractory to maximally tolerated medical treatment. The choice of revascularization technique depends on anatomical characteristics, clinical condition and physician experience. Available data derived from anecdotal evidence view the lack of randomized clinical trials.
心肌桥（MB）是一种常见的先天性异常，在很大一部分患者中无症状。临床表现的高峰期出现在生命的第三和第四个十年。MB 通过不同的机制引起心肌缺血，包括供需不匹配、内皮功能障碍、冠状动脉微血管功能障碍和外部机械压迫。MB 与动脉粥样硬化疾病之间的关联存在争议。最近的研究确立了 MB 与心肌梗死和非阻塞性冠状动脉疾病的显著关联。一线治疗基于β受体阻滞剂和钙通道阻滞剂。伊伐布雷定用于二线治疗。对于最大耐受药物治疗后仍有症状的患者，采用经皮冠状动脉介入治疗、冠状动脉旁路移植术和肌切开术等有创方法。血运重建技术的选择取决于解剖学特征、临床情况和医生经验。现有的数据来源于偶然证据，缺乏随机临床试验。
