Rare myocardial bridging associated with no-reflow phenomena

Yıl 2013, , 104 - 106, 01.06.2013

Mustafa Serkan Karakaş Refik Emre Altekin Sinan Cemgil Özbek Mehmet Kabukçu

https://doi.org/10.5505/sakaryamj.2013.29290

Öz

Myocardial bridge (MB) is a congenital abnormaly that the a part of an epicardial artery follows a route inside myocardium and leads to narrowing with systolic compression. Most commonly seen in left anterior descending artery (LAD). By means of compression and endothelial dysfunction it can lead coronary ischemia and various clinical presentations. Our case presented to our clinic with inferior myocardial infarction and primary percutenous intervention performed for right coronary artery (RCA). No reflow developed during intervention and glycoprotein IIb-IIIa infusion given to patient. Control coronary angiography revealed a dissecting lesion with a 80% stenosis at the distal of RCA after the infarct related lesion and a myocardial bridge with a 99% stenosis at the posterior descending artery (PDA). Myocardial bridging at the PDA is a very rare situation. Percutenous intervention on those lesions during acute coronary syndrome may result with no-reflow phenomena. Myocardial bridging may increase the risk of no-reflow in acute coronary syndromes.

Anahtar Kelimeler

Muscular bridge, Acute coronary syndrome, No-reflow

No-reflow fenomeniyle ilişkili nadir yerleşimli miyokardiyal köprüleme

Öz

Bu yayında akut koroner sendromlarda sorumlu lezyon distalinde kalan miyokardiyal köprülemeyle işlem esnasında gelişebilecek no-reflow fenomeni arasındaki ilişki değerlendirilmiştir. Miyokardiyal köprüleme, epikardiyumda seyreden koroner arterlerin bir bölümünün kas içinde seyretmesi ile ortaya çıkan ve sistolik bası sonucu arterlerde daralmaya yol açan konjenital anomalidir. Neden olduğu sistolik bası ve endotel disfonksiyonu nedeniyle koroner iskemiye yol açarak çeşitli klinik tablolara yol açabilir. Vakamızda alt yüz kalp krizi nedeniyle Sağ Koroner Arter'e (RCA) acil perkütan girişim yapıldı. İşlem sırasında no-reflow gelişmesi nedeniyle hastaya glikoprotein IIb-IIIa infüzyonu verildi. Ardından yapılan kontrol koroner anjiyografide RCA orta bölgede enfarktüsden sorumlu %80 darlık yapan disseke lezyon, takip eden RCA'nın arka inen dalında (PDA) %99 darlık yapan miyokardiyal köprüleme tespit edildi. PDA tutulumlu miyokardiyal köprüleme nadir bir durumdur. Akut koroner sendrom nedeniyle yapılacak perkütan girişimlerde miyokardiyal köprüleme no-reflow gelişme riskini arttırabilir.

Anahtar Kelimeler

Miyokardiyal Köprüleme, Akut koroner sendrom, No-reflow

Kaynakça

• Erbel R,MD; Ge J, MD; Möhlenkamp S,MD. Myocardial bridging a congenital variant as an anatomic risk factor for myocardial infarction. Circulation, 2009;120:357-359.
• Möhlenkamp S, Hort W, Ge J, Erbel R. Update on myocardial bridging. Circulation. 2002;106:2616-2622.
• Diefenbach C, Erbel R, Treese N, Bollenbach E, Meyer J. Incidence of myocardial bridges after adrenergic stimulation and decreasing afterload in patints with angina pectoris, but normal coronary arteries. Z Kardiol. 1994;83:809-815.
• Chen CC, Chen HW, Fu CJ, Lin FC, Wen MS, Liu YC. Myocardial bridging of the right coronary artery inside the right atrial myocardium identified by ECG-gated 64-slice multidetector computed tomography angiography. Chang Gung Med J. 2010;33:216-9.
• Ishikawa Y, Akasaka Y, Ito K, Akishima Y, Kimura M, Kiguchi H et al.Significance of anatomical properties of myocardial bridge on atherosclerosis evolution in the left anterior descending coronary artery. Atherosclerosis 2006;186:380-389.
• Agirbasli M, MD, Hillegass WB JR, MD,MPH, Chapman G.D, MD,Brott B.C,MD. Stent procedure complicated by thrombus formation distal to the lesion with in a muscle bridge. Catheterization and Cardiovascular Diagnosis 1998;43:73-76.
• Ge J, Erbel R, Rupprecht HJ, Koch L, Kearney P, Gorge G, Haude M, Meyer J. Comparision of intravascular ultrasound and angiography in the assessment of myocardial bridging. Circulation 1994;89:1725-1732.
• Ge J, Erbel R, Gorge G, Haude M, Meyer J. High wall shear stres proximal to myocardial bridging and atherosclerosis: intracoronary ultrasound and pressure measurements. Br Heart J. 1995;73:462-465.
• Vrints CJ.Pathophsiology of no-reflow phenomenon. Acute Card. Care 2009;11(2):69-76