Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
General Surgery Residency Program, Department of Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex.
J Thorac Cardiovasc Surg. 2024 Oct;168(4):1203-1212. doi: 10.1016/j.jtcvs.2023.12.024. Epub 2024 Jan 8.
To describe clinical, functional, surgical, and outcomes data in pediatric patients with a myocardial bridge (MB) evaluated and managed following a standardized approach.
Prospective observational study included patients evaluated in the Coronary Artery Anomalies Program. Anatomy was determined by computed tomography angiography, myocardial perfusion by stress perfusion imaging, and coronary hemodynamic assessment by cardiac catheterization.
In total, 39 of 42 patients with a complete evaluation for MB were included (December 2012 to June 2022) at a median age of 14.1 years (interquartile range, 12.2-16.4). Sudden cardiac arrest occurred in 3 of 39 (8%), exertional symptoms in 14 (36%), and no/nonspecific symptoms in 7 (18%) patients. Exercise stress test was abnormal in 3 of 34 (9%), stress perfusion imaging in 8 of 34 (24%), and resting instantaneous wave-free ratio ≤0.89 or diastolic dobutamine fractional flow reserve ≤0.80 in 11 of 21 (52%) patients. As a result, 15 of 39 (38%) patients were determined to have hemodynamically significant MB, 1 of 15 patients started beta-blocker, and 14 of 15 were referred for surgery. Myotomy (n = 11) and coronary bypass (n = 1) were performed successfully, resulting in improved symptoms and stress testing results. One patient required pericardiocentesis postoperatively, and all were discharged without other complications. At median follow-up time of 2.9 (1.8-5.8) years, all (except 2 pending surgery) were doing well without exercise restriction.
Pediatric patients with MB can present with myocardial ischemia and sudden cardiac arrest. Provocative stress test and intracoronary hemodynamic tests helped risk-stratify symptomatic patients with MB and concern for ischemia. Surgical repair was safe and effective in mitigating exertional symptoms and stress test results, allowing patients to return to exercise without restriction.
描述经过标准化评估和管理的心肌桥（MB）患儿的临床、功能、手术和结局数据。
前瞻性观察性研究纳入了在冠状动脉异常计划中接受评估的患者。通过计算机断层扫描血管造影术确定解剖结构，通过应激灌注成像确定心肌灌注，通过心导管术评估冠状动脉血流动力学。
2012 年 12 月至 2022 年 6 月期间，共有 39 例（占完整评估的 39/42 例）MB 患儿符合纳入标准，中位年龄为 14.1 岁（四分位距 12.2-16.4）。3 例（8%）患儿发生心源性猝死，14 例（36%）患儿有运动性症状，7 例（18%）患儿无症状或症状不典型。34 例患儿中有 3 例（9%）运动应激试验异常，34 例中有 8 例（24%）应激灌注成像异常，21 例中有 11 例（52%）即刻无波比值≤0.89 或舒张多巴酚丁胺分数流储备值≤0.80。因此，39 例患儿中有 15 例（38%）被确定为存在血流动力学意义的 MB，其中 1 例开始使用β受体阻滞剂，15 例均被转至外科治疗。11 例行心肌切开术，1 例行冠状动脉旁路移植术，手术均成功，患者症状和应激试验结果均改善。1 例患者术后需行心包穿刺术，所有患者均无其他并发症出院。中位随访时间为 2.9 年（1.8-5.8 年），除 2 例待手术的患者外，所有患者均恢复良好，无运动受限。
患有 MB 的儿科患者可能会出现心肌缺血和心源性猝死。有创性应激试验和冠状动脉内血流动力学检查有助于对有症状的 MB 患者进行风险分层，并评估其是否存在缺血。外科修复术安全有效，可减轻运动性症状和应激试验结果，使患者能够在不受限制的情况下恢复运动。
