孤立性心肌桥-壁冠状动脉患者的多层螺旋CT及临床分析

试图分析孤立性心肌桥-壁冠状动脉（MB—MCA）病变患者的多层螺旋CT（MSCT）的影像学特点与临床表现之间的内在联系。回顾性收集自2003年1月至2007年3月，在我院住院并行MSCT，保存有清楚影像学资料，临床排除有其他心脏病合并症的MB—MCA患者，共53例，发现MB—MCA病变65处。平均年龄（57．3±12．6）岁，其中男性27例，LAD病变59例。MCA长度（20．8±11．2）mm，MB厚度（2．0±1．6）mm。58．5％的患者有心电图改变，大部分为女性，有胸部不适症状者占90．6％。单纯应用非二氢吡啶类钙离子拮抗剂者15例，治疗有效率达到73．3％（11例），单纯应用β受体阻滞剂者12例，症状缓解率达到66．7％（9例）。单纯应用硝酸酯类药物者16例，仅有2倒（12．5％）缓解。MB—MCA可能导致心肌缺血和临床症状，可进行干预性治疗；对硝酸酯类药物不能缓解的胸痛患者要想到MB—MCA可能，有条件者应该进行MSCT等影像学检查，诊断明确的可以试用β受体阻滞剂及非二氧吡啶娄拮抗剂．

The Clinical and Imaging Characteristics of Isolated Myocardial Bridge-- Mural Coronary Artery Diagnosed with MSCT

Studies on isolated myocardial bridge-- mural coronary artery （MB--MCA） are still rare, the aim of this study is to find the intra--relationship between clinical characteristics of these patients and imaging features found with 16 row Multiple--sliced spiral CT（MSCT）. Retrospectively collecting those patients diagnosed as myocardial bridge with the examination of 16 row MSCT done in our hospital from January 2003 to March 2007, excluding other organic cardiac diseases by clinical analysis. Two radiologists analyzed these patients again on the CT workstation. Completed clinical data were re --analyzed by cardiologists. Totally 53 cases of isolated MB--MCA patients were included in our study. Their average aged 57.3±12.6,including 27 male patients. Sixty five locale of MB--MCA were found, of which 59 （90.8 %）were located on the left anterior descending branch（LAD）. The length of bridged segments of MCA in patients with complete MB was （20.8±11.2）mm, the thickness of MB was （2.0±1.6） mm. 58.5% patients had non specific ST--T change in electrocardiography（ECG）, of which mostly were female. 90.6% of patients had clinical symptoms related to the chest area. Beta--blockers and non--dihydropyridine calcium channel blockers could effectively relieve angina - like symptoms with an effective rate as 66.7%（9 of 12 cases） and 77.3 %（11 of 15 cases） respectively. Nitrates might play no role with a low effective rate as 12.5%（ 2 of 16 cases）. MB--MCA might lead to clinical symptoms and ECG abnormality. For patients of low coronary heart disease risk whose angina could not effectively relieved with nitrates, non--invasive MSCT coronary angiography may confirm the diagnosis of MB--MCA. Beta--blockers and non--dihydropyridine calcium channel blockers could be ideal choices for isolated MB--MCA patients.