应用经胸冠脉超声诊断心肌桥的初探
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摘要
目的探讨经胸冠脉超声(TTE)对心肌桥的显示率及其超声特点。方法对38例我院经冠脉CTA确诊的心肌桥患者行TTE检查,记录心肌桥位置、血流速度,留存图像。结果 TTE发现心肌桥所在冠脉分支血流速度加快者24例,血流速度为42～82cm/s。其中左前降支近段5例,左前降支中远段18例,右后降支1例。在TTE未见明显异常的14例患者中,有8例冠脉CTA诊断为浅肌桥,其余6例心肌桥位于左钝缘支4例及右后降支2例。结论 TTE是一种简单易行、安全有效的筛查心肌桥的无创性方法,心肌桥处冠脉血流速度加快,且有着特殊的频谱形态。但对于浅肌桥、左钝缘支及右后降支心肌桥的显示尚不理想。将TTE应用在心肌桥的早期诊断中可能会发挥重要的临床价值。
Objective To explore the case detection rate and the features of ultrasonic of the myocardial bridge by transthoracic coronary echocardiography(TTE).Methods TTE were performed on 38 patients which had been diagnosised with myocardial bridge confirmed by coronary CTA in our hospital,recording the position and velocity of myocardial bridge and memorizing images and date information.Results TTE detected 24 cases of blood velocity increasing in the coronary artery where the myocardial bridge was located,with the blood flow velocity ranged from 42 to 82 cm/s.The myocardial bridge located in the proximal segments of left anterior descending branch accounted for 5,the middle segments of left anterior descending branch accounted for 18,the right posterior descending branch accounted for 1.Among the 14 patients with no obvious abnormality in TTE,8 cases were diagnosed as superficial myocardial bridge by coronary CTA,and the remaining 6 cases were located in the left obtuse marginal branch 4 cases,right posterior descending branch 2 cases.Conclusions TTE is a safe,simple and easy-to-follow method in diagnosing myocardial bridge,the blood flow speed of coronary artery at the myocardial bridge is accelerated,and there are special color Doppler flow spectrum.However,it is not ideal to detecting superficial myocardial bridge and the myocardial bridge of the lefe obtuse marginal branch and the right posterior descending branch.The preliminary application of TTE may play an important role in the early diagnosis of myocardial bridge.
Objective To explore the case detection rate and the features of ultrasonic of the myocardial bridge by transthoracic coronary echocardiography(TTE).Methods TTE were performed on 38 patients which had been diagnosised with myocardial bridge confirmed by coronary CTA in our hospital,recording the position and velocity of myocardial bridge and memorizing images and date information.Results TTE detected 24 cases of blood velocity increasing in the coronary artery where the myocardial bridge was located,with the blood flow velocity ranged from 42 to 82 cm/s.The myocardial bridge located in the proximal segments of left anterior descending branch accounted for 5,the middle segments of left anterior descending branch accounted for 18,the right posterior descending branch accounted for 1.Among the 14 patients with no obvious abnormality in TTE,8 cases were diagnosed as superficial myocardial bridge by coronary CTA,and the remaining 6 cases were located in the left obtuse marginal branch 4 cases,right posterior descending branch 2 cases.Conclusions TTE is a safe,simple and easy-to-follow method in diagnosing myocardial bridge,the blood flow speed of coronary artery at the myocardial bridge is accelerated,and there are special color Doppler flow spectrum.However,it is not ideal to detecting superficial myocardial bridge and the myocardial bridge of the lefe obtuse marginal branch and the right posterior descending branch.The preliminary application of TTE may play an important role in the early diagnosis of myocardial bridge.
引文
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[8]黄朴忠,孙强,关汝明,等.经胸二维超声扫描对冠状动脉硬化斑块的检出[J].中国超声医学杂志,2007,23(10):757-759.
[9]黄朴忠,王晓洋,李焱,等.经胸冠状动脉超声显像技术对冠状动脉正常血流显示能力和血流速度的研究[J].中国超声医学杂志,2007,23(11):836-838.
[2] SUN J L,HUANG W M,GUO J H,et al.Relationship Between Myocardial Bridging and Coronary Arteriosclerosis[J].Cell Biochem Biophys,2013,65(3):485-489.
[3]赵莹莹,黄朴忠,李焱,等.经胸冠状动脉超声与动态心电图对冠心病的诊断初探[J].中国超声医学杂志,2014,30(8):690-693.
[4]黄朴忠,赵莹莹,徐升,等.经胸冠状动脉超声成像对冠状动脉内支架的显示能力探讨[J].中国超声医学杂志,2014,30(9):782-785.
[5] ANGELINI P.Coronary myocardial bridges:pathophysiology and clinical relevance[J].J Am Coll Cardiol,2014,64(20):2178.
[6] PEREZ-POMARES J M,DE LA POMPA J L,FRANCO D,et al.Congenital coronary artery anomalies:a bridge from embryology to anatomy and pathophysiology-aposition statement of the development,anatomy,and pathology ESC Working Group[J].Cardiovasc Res,2016,109(2):204-216.
[7]刘天壤,李武,徐海杰,等.64排CT冠状动脉血管成像与冠状动脉造影诊断冠状动脉心肌桥的价值比较[J].中国CT和MRI杂志,2015,13(1):109-111.
[8]黄朴忠,孙强,关汝明,等.经胸二维超声扫描对冠状动脉硬化斑块的检出[J].中国超声医学杂志,2007,23(10):757-759.
[9]黄朴忠,王晓洋,李焱,等.经胸冠状动脉超声显像技术对冠状动脉正常血流显示能力和血流速度的研究[J].中国超声医学杂志,2007,23(11):836-838.