??????? coronary myocardial bridge

1
??????? coronary myocardial bridge

• ??????????????
• ???

2
??

• ?????????????,???????????????????????????????????,
  ???????????????????????????????,??????????(myocard
  ail bridge MB),???????(intramural coronary)?

3
??

• ???1737????????
• 1922?,Crainiciana????????(myocardial
  bridge,MB)???
• 1960?Portsmann?lwig??????????????????????19???,???
  ????????

4
??

• ????????????,???????????????????????
• ????????????????????,??????????5.4-85.7,????????
  ???0.52.5
• ??????,???????????

5
??

• ????????????????????MB??????????MB??????????,?
  ???????MB??????????????????????????

6
???????

• ????????(98.08) ,????????(86.27) ,??????(1.92)
  ,??????Mb???10mm-30mm,??2-4mm

7
???????

• ???????
• ??-???(???),??????????,???????????????????????
• ??-???(?),??????????????????????????????????,?????
  ???????????????????,?????????????????????

8
???????

• (1)?????????? 
• ???????????????????5-30,???????????,???????
• ?????????????????????????????????????????

9
???????

• (2)??mb????????
• mb????????????????
• ???????????????
• klues?2????????????????????????????????,??????????
  ??,????????????????

10
???????

• ???????????
• A ??????,???????????????,?????????,???????????????
  
• B ????,???/????????,mb??????????,????,

11
???????

• C??????????A2????????
• D????????????
• E??????????

12
???????

• ????????????
• (1)????????
• (2)mb?????????????
• (3)Mb????????????????

13
???????

• A ????????????
• ????????????????,???????????,?????????????,???????
  ????,
• ?????????????????????,??????????,????????????????,
  
• ???????????????????,???????????????????,??????????
  ?,??????????????????????????????,??????????

14
???????

• B Mb?????????????,?????????????????????,???????
  ??????

15
???????

• C Mb????????????????,???????mb?????????????????
  86, mb?????????????????????????????,??mb?????????
  ??????????mb?????????????????????,????????no??????
  ?????????????????????

16
????

• ??????
• ????????????????????????????????????????????
• ????MB??????????,????????????????,????????????????
  ???????????????

17
??

• ????(CAG)?????????????????????????,?????????????
  ?,???????(??????????)
• ????CT??????(CTA)??????(IVUS)?

18
??CTA

• ???????,??????(???)?????????(???)?????????,???????
  ???????????????????????(????)???(??)??,????????,Ao
  ?????

19
??CAG

• Fig. 1. The myocardial bridge covered the left
  anterior descending coronary
• artery.
• A Left anterior oblique projection of the left
  anterior descending coronary
• artery during diastole.
• B Left anterior oblique projection of the left
  anterior descending coronary
• artery during systole, with arrows indicating the
  segment of systolic distal
• bridging.

20
??CAG

• Fig. 2. The myocardial bridge was found over the
  median branch of the left
• circumflex coronary artery.
• A Left anterior oblique projection of the left
  circumflex coronary artery
• during diastole.
• B Left anterior oblique projection of the left
  circumflex coronary artery
• during systole, with arrows indicating the
  segment of systolic proximal
• bridging.

21
??CAG

• Fig. 3. The greater length of the myocardial
  bridge completely covered the
• mid portion and the beginning distal portion of
  the left anterior descending
• coronary artery.
• A Left anterior oblique projection of the left
  anterior descending coronary
• artery during diastole.
• B Left anterior oblique projection of the left
  anterior descending coronary
• artery during systole, with arrows indicating the
  segment of systolic mid and
• distal bridging.

22
??CAG

• ??????????????
• I??????????50,??????
• II?????50-70??,????????,???????????
• III?????75,??????,??????????,????????

23
??IVUS

• ???????????????????????????,??????????????????
  
• ?????????????(?????????????????)?????????????????
  ??????,???????????????????????????

24
??

• ????
• ????
• ????

25
??????

• ß?????
• ???????,?????????????,????,?????,?????????(??gt130?
  /?),????????????????????,???/?????????,???????????
  ????

26
??????

• ??????
• ???????,????????,????????,?????????,??????????,???
  ??????,??????????????,???????????

27
??????

• ?????????
• ?????????
• ????????????????????????,?????

28
????

• ?????? ???????????????????? ???,????????
• ?????????????????????,?Multi-Link??????????12?????
  ????????(gt14????)????????????

29
????

• ??PTCA?????,?????,????50
• Ferreira ??????????????????????????????,?PCI?????

30
????

• ???????????1975??binet?????????,?????????????,???
  ??????????,???????,????????????????????
• ???????????????

31
????

• ?????????,??????????????????????,????????????????
  ???????

32
??

• ????,??????????????????????????????,??????81?????5
  ??????,????61??????????11?,??????????97.5?98,???
  ????????,???????????????????

33
??

• ????????????????
• ??????????????????
• ??????,?????,????????????????
• ???????????
• ??????,?????????????????????????
• ?????????,????

34
(No Transcript)