心肌桥松解术应用进展  

Application progress of myocardial bridging unroofing

作　　者：史轶群 刘健[1] 刘巍[2] SHI Yi-qun;LIU Jian;LIU Wei(Department of Cardiology,Peking University People’s Hospital,Beijing 100044,China;Department of Cardiology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]北京大学人民医院心内科,北京市100044 [2]首都医科大学附属积水潭医院心内科

出　　处：《中国心血管病研究》2025年第2期183-188,共6页Chinese Journal of Cardiovascular Research

基　　金：首都临床特色诊疗技术研究及转化(Z221100007422096);北京大学人民医院研究与发展基金(RDGS2022-08)。

摘　　要：心肌桥是一种冠状动脉先天性解剖变异,即走行于心外膜的冠状动脉的部分节段被心肌纤维包绕,最常见于左前降支(LAD)。心肌桥一般被认为是良性病变,但近年来研究发现,心肌桥有可能导致心绞痛症状、急性冠状动脉综合征、心律失常甚至心源性猝死。对于有症状的心肌桥患者,应首先采用药物治疗,但在最大耐受剂量药物治疗无效时,心肌桥松解术是最佳的选择。心肌桥松解术可使患者西雅图心绞痛量表(SAQ)5个维度的评分均得到明显改善,且手术安全性高,具有较好的近、中期预后。本文详细评述了当前心肌桥松解术在不同人群及心肌桥合并其他疾病时的应用现状,详细比较了松解术与其他不同手术方法及药物治疗的区别,同时对相关辅助技术进展进行总结。Myocardial bridging is a congenital variation of the epicardial coronary artery that the coronary artery segment is covered by myocardial fiber,which is most commonly observed at the left anterior descending branch(LAD).Myocardial bridging is generally considered as a benign lesion in the past.However,it has been found that myocardial bridging can lead to angina symptoms,acute coronary syndromes,arrhythmias and even sudden cardiac death recently.For symptomatic myocardial bridging patients,drug therapy is used first,but myocardial bridging supra-arterial myotomy is the best choice when the maximum tolerated dose drug therapy fails.The supra-arterial myotomy can significantly improve the score of 5 dimensions of Seattle angina questionnaire(SAQ)with high surgical safety and good prognosis of short-term and medium-term.This article provides a detailed review of the current application status of myocardial bridging supra-arterial myotomy in different populations and diseases which myocardial bridging comorbid with.It compares the differences among supra-arterial myotomy and other treatments in detail.It also summarizes the progress ofrelevant auxiliary technologies.

关 键 词：心肌桥 心肌桥松解术 血流动力学 西雅图心绞痛问卷 心肌缺血 

分 类 号：R543.3[医药卫生—心血管疾病] R540.4[医药卫生—内科学]