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Yu Yarong,Yu Lihua,Dai Xu,Zhang Jiayin 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.12
Objective: To investigate the diagnostic performance of CT fractional flow reserve (CT-FFR) for myocardial bridging-related ischemia using dynamic CT myocardial perfusion imaging (CT-MPI) as a reference standard. Materials and Methods: Dynamic CT-MPI and coronary CT angiography (CCTA) data obtained from 498 symptomatic patients were retrospectively reviewed. Seventy-five patients (mean age ± standard deviation, 62.7 ± 13.2 years; 48 males) who showed myocardial bridging in the left anterior descending artery without concomitant obstructive stenosis on the imaging were included. The change in CT-FFR across myocardial bridging (ΔCT-FFR, defined as the difference in CT-FFR values between the proximal and distal ends of the myocardial bridging) in different cardiac phases, as well as other anatomical parameters, were measured to evaluate their performance for diagnosing myocardial bridging-related myocardial ischemia using dynamic CT-MPI as the reference standard (myocardial blood flow < 100 mL/100 mL/min or myocardial blood flow ratio ≤ 0.8). Results: ΔCT-FFRsystolic (ΔCT-FFR calculated in the best systolic phase) was higher in patients with vs. without myocardial bridging-related myocardial ischemia (median [interquartile range], 0.12 [0.08–0.17] vs. 0.04 [0.01–0.07], p < 0.001), while CT-FFRsystolic (CT-FFR distal to the myocardial bridging calculated in the best systolic phase) was lower (0.85 [0.81–0.89] vs. 0.91 [0.88–0.96], p = 0.043). In contrast, ΔCT-FFRdiastolic (ΔCT-FFR calculated in the best diastolic phase) and CT-FFRdiastolic (CT-FFR distal to the myocardial bridging calculated in the best diastolic phase) did not differ significantly. Receiver operating characteristic curve analysis showed that ΔCT-FFRsystolic had largest area under the curve (0.822; 95% confidence interval, 0.717–0.901) for identifying myocardial bridging-related ischemia. ΔCT-FFRsystolic had the highest sensitivity (91.7%) and negative predictive value (NPV) (97.8%). ΔCT-FFRdiastolic had the highest specificity (85.7%) for diagnosing myocardial bridging-related ischemia. The positive predictive values of all CT-related parameters were low. Conclusion: ΔCT-FFRsystolic reliably excluded myocardial bridging-related ischemia with high sensitivity and NPV. Myocardial bridging showing positive CT-FFR results requires further evaluation.
심근교 환자에서 관상동맥 중재술 후 이면성 긴장의 변화를 보인
김석훈 ( Seok Hoon Kim ),박정호 ( Jeong Ho Park ),안정명 ( Jeong Myung Ahn ),김산 ( San Kim ),이정남 ( Jeong Nam Lee ),조경임 ( Kyoung Im Cho ),김태익 ( Tae Ik Kim ) 대한내과학회 2006 대한내과학회지 Vol.71 No.6
The myocardial bridge of the coronary arteries is observed by coronary angiography at a rate of <5% and ordinarily dues not constitute a hazard. Occasionally, the compression of a coronary artery by a myocardial bridge can be associated with the clinical manifestations of myocardial ischemia during strenuous physical activity and might even result in a myocardial infarction or initiate malignant ventricular arrhythmias. A few cases of percutaneous coronary intervention for a myocardial bridge have been reported. However, there are few reports of the changes in the 2-dirnensional strain in the myocardial bridge. We encountered a case of a myocardial bridge in a 48-year-old male patient who had refractory angina despite continuous medication with a beta-blocker and calcium channel blocker. The 2-dimensional strain of the patient changed after percutaneous coronary intervention with stents. We report the first case in Korea with a review of the relevant literature. (Korean J Med 71:673-677, 2006)
Ventricular fibrillation due to coronary spasm at the site of myocardial bridge
Jung Gi Choi,Cheon Hee Park,Cheol Seung Lee,June Seog Choi 대한마취과학회 2010 Korean Journal of Anesthesiology Vol.58 No.1
Myocardial bridge is a congenital anomaly characterized by narrowing of some of the epicardial coronary arterial segments running in the myocardium during systole. Occasionally, the compression of a coronary artery by a myocardial bridge can be associated with the clinical manifestations of myocardial ischemia, and might even trigger a myocardial infarction or malignant ventricular arrhythmias. We report a case of ventricular fibrillation due to coronary spasm at the site of myocardial bridge. A 56-year-old man who had suffered from bronchial asthma was given remifentanil combined with sevoflurane in general anesthesia for endoscopic sinus surgery. During the surgery, ventricular fibrillation occurred following coronary spasm with bradycardia, hypotension, bronchospasm. we found myocardial bridge that coincided with an area of coronary spasm after coronary angiography. (Korean J Anesthesiol 2010; 58: 99~103)
흉통(胸痛)이 있는 심근교(myocardial bridge) 환자의 치험 1례
김보람,최동준,임성우,Kim, Bo-ram,Choi, Dong-jun,Lim, Sung-woo 대한중풍순환신경학회 2009 대한중풍.순환신경학회지 Vol.10 No.1
Myocardial bridging, a congenital coronary anomaly, is present when a segment of a major epicardial coronary artery, runs intramurally through the myocardium. So with each systole, the coronary artery is compressed. It has been associated with angina, arrhythmia, myocardial infarction and sudden cardiac death. This is a case of a 39-year-old woman who was diagnosed myocardial bridge. She complained of recurrent chest pain, palpitation. We diagnosed her as Gyesimtong(JiXiTong, 悸心痛), and prescribed Jeongkicheonhyang-tang(正氣天香湯). After treatment, all of the symptoms had improved and have not recurred for 18 months. This case suggests that oriental medicine therapy can be applicable to improve in symptoms of myocardial bridge.
An Overview of Myocardial Bridging With a Focus on Multidetector CT Coronary Angiographic Findings
고성민 대한심장학회 2008 Korean Circulation Journal Vol.38 No.11
Myocardial bridging (MB) is a common anatomical variant rather than a congenital anomaly, and it is usually considered benign. It is generally confined to the mid-portion of the left anterior descending coronary artery. Atherosclerotic plaques are often located in the segment proximal to the bridged segment, although the tunneled segment is typically spared. Conventional coronary angiography is the gold standard for detection, but it is invasive and may not be sensitive enough to detect a thin bridge. The prevalence of MB reported in multidetector CT (MDCT) coronary angiographic series has ranged from 3.5% to 30.5% in patients with chest pain or with suspected or known coronary artery disease. Today, MDCT coronary angiography is an alternative noninvasive imaging tool that allows for easy and accurate evaluation of MB. Myocardial bridging (MB) is a common anatomical variant rather than a congenital anomaly, and it is usually considered benign. It is generally confined to the mid-portion of the left anterior descending coronary artery. Atherosclerotic plaques are often located in the segment proximal to the bridged segment, although the tunneled segment is typically spared. Conventional coronary angiography is the gold standard for detection, but it is invasive and may not be sensitive enough to detect a thin bridge. The prevalence of MB reported in multidetector CT (MDCT) coronary angiographic series has ranged from 3.5% to 30.5% in patients with chest pain or with suspected or known coronary artery disease. Today, MDCT coronary angiography is an alternative noninvasive imaging tool that allows for easy and accurate evaluation of MB.
증례보고 : 심근교로 인한 불안정형 협심증을 가진 환자의 마취경험
이원국 ( Won Kook Lee ),김은주 ( Eun Ju Kim ),이지향 ( Ji Hyang Lee ),이상곤 ( Sang Gon Lee ),반종석 ( Jong Suk Ban ),민병우 ( Byung Woo Min ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1
An anatomical anomaly, in which myocardial fibers make a bridge over the epicardial coronary artery, is known as the myocardial bridge. The clinical significance of this anomaly has been emphasized because serious cardiac diseases, such as myocardial infarctions or sudden death, can occur. We experienced the anesthetic management of a 72-year-old female patient with a myocardial bridge under general anesthesia for cholecystitis. (Korean J Anesthesiol 2007; 53: 119~22)
Man Zhang,강웅철,문찬일,한승환,안태훈,신익균 대한심장학회 2010 Korean Circulation Journal Vol.40 No.3
We successfully rescued a patient whose coronary artery perforated following implantation of a drug-eluting stent (DES), by deploying a stent-graft in symptomatic myocardial bridging. Our case demonstrated that coronary perforation could be handled without difficulty when perforated myocardial bridging is confined to the interventricular groove.