ABSTRACT

Background

Myocardial bridging is largely considered to be a benign, symptomless congenital anomaly of the coronary arteries in which the intramyocardial coronary course is partially ‘tunnelled’ and leads to vessel compression during ventricular systole. There are few data regarding children.

Objective

To report on myocardial bridging observed in children seeking medical help in the paediatric emergency room.

Case presentation

A series of four children aged 6–13 years with symptomatic myocardial bridging but no other underlying cardiac abnormalities is reported. They were admitted to the paediatric emergency department during 2013–2016, three with chest pain after physical activity and one with septic shock.

Results

Heart computed tomography scan in the first three demonstrated myocardial bridging of the left anterior descendent coronary artery’s branches; their 2-year follow-up was uneventful. The fourth patient presented with ventricular fibrillation 24 hours after admission and at autopsy there was an intramyocardial tract 4 cm long on the left anterior descendent coronary artery.

Conclusions

This case series demonstrates that myocardial bridging can be symptomatic in children with no underlying cardiac disorders and should be included in the differential diagnosis of exertional chest pain and/or arrhythmias.

Abbreviations: CRP, C-reactive protein; CT, computed tomography; D1, diagonal 1 artery; ECG, electrocardiogram; ED, emergency department; KD, Kawasaki disease; LAD, left anterior descending coronary artery; MB, myocardial bridging; RI, ramus intermedius artery; TN, troponin.

中文翻译：

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四名无基础心脏病儿童的心肌桥相关并发症：病例系列

摘要

背景

心肌桥在很大程度上被认为是一种良性、无症状的冠状动脉先天性异常，其中心肌内冠状动脉过程部分“隧道化”并导致心室收缩期间的血管受压。关于儿童的数据很少。

客观的

报告在儿科急诊室寻求医疗帮助的儿童中观察到的心肌桥接现象。

案例展示

报告了一系列 4 名 6-13 岁有症状性心肌桥但没有其他潜在心脏异常的儿童。他们在 2013 年至 2016 年期间被送入儿科急诊科，其中 3 人在体育活动后出现胸痛，1 人出现感染性休克。

结果

前三个心脏计算机断层扫描显示左冠状动脉前降支的心肌桥接；他们 2 年的随访很顺利。第 4 名患者在入院 24 小时后出现心室颤动，尸检时在左冠状动脉前降支有一条 4 cm 长的心肌内束。

结论

该病例系列表明，心肌桥在没有潜在心脏疾病的儿童中可能是有症状的，应包括在劳力性胸痛和/或心律失常的鉴别诊断中。

缩写： CRP，C反应蛋白；CT，计算机断层扫描；D1，对角1动脉；心电图、心电图；急诊科，急诊科；KD，川崎病；LAD，左冠状动脉前降支；MB，心肌桥接；RI，中间支动脉；TN，肌钙蛋白。