intramyokardialer Verlauf der Koronararterien

Congenital
coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. (a) Volume-rendered reconstruction showing myocardial bridge of the left anterior descending artery in a 65-year-old man who was referred for the exclusion of coronary artery disease. (b) Axial images revealing myocardial bridge with intramuscular course of the proximal left anterior descending artery between the left ventricular muscles.
bmccardiovascdisord.biomedcentral.com • CC-by-2.0
Angiographic
images showing a bridge on the left anterior descending coronary artery (LAD) in a male patient of 65 years. A1) Right anterior oblique view taken at end systole. The compressed vessel segment is indicated by the two arrows. B1) Left anterior oblique view taken nearly at the same instant. A2) Same view as in A1, but taken 133 ms later. The tunneled segment is no longer compressed. B2) Same view as in B1 but 133 ms later.
Wikipedia • CC BY 2.0
Congenital
coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. A patient with angina pectoris underwent coronary angiography. Images reveal myocardial bridging in the mid LAD (a) during diastole and (b) during systole.
bmccardiovascdisord.biomedcentral.com • CC-by-2.0
Anomalous
course of coronary arteries • Myocardial bridging - Ganzer Fall bei Radiopaedia
Hacking, C. Myocardial bridging. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-37317 • CC by-nc-sa 3.0 (modified)
Myocardial
bridging of the coronary arteries • Bridging of the left anterior descending artery - Ganzer Fall bei Radiopaedia
Nikos V, Bridging of the left anterior descending artery. Case study, Radiopaedia.org (Accessed on 03 Feb 2023) https://doi.org/10.53347/rID-22808 • CC by-nc-sa 3.0 (modified)
Myocardial
bridging of the coronary arteries • Coronary artery disease - Ganzer Fall bei Radiopaedia
Feger J, Coronary artery disease. Case study, Radiopaedia.org (Accessed on 03 Feb 2023) https://doi.org/10.53347/rID-156986 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Myocardial bridging is a common congenital anomaly of the coronary arteries where a coronary artery courses through the myocardium.

Epidemiology

It is found approximately in 20-30% of the adult population in autopsy studies. The incidence in coronary angiograms is between 2-15% and can be easily seen at coronary CT angiography. It occurs more frequently in patients with hypertrophic cardiomyopathy (HCM), and is associated with :

Pathology

Normally major coronary arteries follow an epicardial course throughout their length, but in some cases, segments of the coronary arteries may course intramurally into the myocardium (tunnelled artery).

Myocardial bridging may be described as:

  • superficial (incomplete)
  • deep (complete)
Location

Bridging is typically described for left anterior descending artery (LAD), with the mid segment of the LAD considered the most common location ; however, other major coronary arteries can also be involved .

Clinical presentation

Myocardial bridging does not produce any symptoms in the majority of patients. However, conditions which increase the amount of systolic compression (e.g. hypertrophic cardiomyopathy) and/or decrease diastolic filling disproportionately (e.g. rapid heart rates) may exacerbate the myocardial oxygen supply/demand mismatch, resulting in troponin positive ischemic chest pain with complications such as :

Radiographic features

CT and angiography
  • both angiography and coronary artery MDCT can detect LAD myocardial bridging
    • angiographic diagnosis is by demonstrating an indirect sign called milking effect
    • coronary artery MDCT directly shows a portion or all of the artery in a intramyocardial location
    • coronary artery MDCT is often better at detecting RCA myocardial bridging
  • the bridged segment often appears to be free of atherosclerosis
Cardiac MRI including perfusion and MDE sequences
  • Regional wall motion abnormality
  • Perfusion defect pertaining to the affected vascular territory (correlates with MPS perfusion abnormality)
  • T2 hyperintensity and mild T1 delayed myocardial enhancement within affected vascular territory.

Treatment and prognosis

Some reports are suggesting the efficacy of calcium channel blockers in symptomatic patients .

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu intramyokardialer Verlauf der Koronararterien:
atypischer
Verlauf der Koronararterien
bmccardiovascdisord.biomedcentral.com • CC-by-2.0
Normvarianten
Koronararterien
Wikipedia • CC BY-SA 4.0