Cardiovascular Center, Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, China.
Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
J Int Med Res. 2024 Aug;52(8):3000605241271891. doi: 10.1177/03000605241271891.
Median arcuate ligament (MAL) syndrome, otherwise known as celiac artery compression syndrome, is rare and is characterized by celiac artery compression by the median arcuate ligament. We report a unique case of MAL syndrome with recurrent myocardial infarction as the primary manifestation, and offer new pathophysiological insights. A man in his early 50s experienced recurrent upper abdominal pain, electrocardiographic changes, and elevated troponin concentrations, which suggested myocardial infarction. Contrast-enhanced computed tomography showed considerable celiac artery stenosis due to MAL syndrome. The patient was diagnosed with MAL syndrome and acute myocardial infarction. He declined revascularization owing to economic constraints, and opted to have conservative treatment with Chinese herbal extracts and medications. He succumbed to sudden cardiac death during a subsequent abdominal pain episode. The findings from this case show that MAL syndrome can present with recurrent myocardial infarction rather than typical intestinal angina symptoms. The pathophysiological link may involve intestinal and cardiac ischemia. An accurate diagnosis and appropriate management of MAL syndrome require careful evaluation and investigation.
中位弓状韧带（MAL）综合征，又称腹腔动脉压迫综合征，较为罕见，其特征为腹腔动脉被中位弓状韧带压迫。我们报告了一例以复发性心肌梗死为主要表现的 MAL 综合征的独特病例，并提供了新的病理生理学见解。一位 50 多岁的男性反复出现上腹痛、心电图改变和肌钙蛋白浓度升高，提示心肌梗死。增强 CT 显示 MAL 综合征导致腹腔动脉明显狭窄。患者被诊断为 MAL 综合征和急性心肌梗死。由于经济限制，他拒绝了血运重建，并选择接受中药提取物和药物的保守治疗。在随后的腹痛发作中，他死于心源性猝死。该病例的发现表明，MAL 综合征可表现为复发性心肌梗死，而不是典型的肠绞痛症状。病理生理学联系可能涉及肠道和心脏缺血。准确诊断和适当治疗 MAL 综合征需要仔细评估和调查。
