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Abstract
RÉSUMÉ
Le pont myocardique est une malformation coronaire, souvent présente dès la naissance, où une artère coronaire, principalement l'artère interventriculaire antérieure, traverse le muscle myocardique. Bien que l'angiographie soit toujours la méthode de diagnostic privilégiée, elle montre typiquement une compression systolique connue sous le nom de "milking". Bien que souvent bénin et sans symptômes, le pont myocardique peut entraîner des complications graves, voire mortelles. Nous rapportons le cas d'une femme venue consulter pour douleurs rétrosternales sans irradiation, survenues lors de ses trajets matinaux et parfois le soir, intermittentes depuis plus d'un an et devenant plus fréquentes et intenses. Une coronarographie a été réalisée montrant une opacification des deux artères coronaires via un accès fémoral, identifiant un pont myocardique significatif impliquant la portion proximale moyenne de l'artère inter ventriculaire antérieure, avec une compression systolique de 50 à 70% et l'absence de lésions artérioscléreuses significatives dans l'artère coronaire droite. la patiente a été classée comme Schwarz 1 et a été mise sous traitement antiplaquettaire (75 mg/jour d'aspirine), inhibiteur calcique (10 mg/jour d'amlodipine) pour l'hypertension artérielle, tout en mettant l'accent sur les modifications du mode de vie incluant la perte de poids et l'exercice physique régulier.
ABSTRACT
Myocardial bridging is a coronary malformation, often present from birth, where a coronary artery, mainly the anterior interventricular artery, crosses the myocardial muscle. Although angiography is still the preferred method of diagnosis, it typically shows systolic compression known as ‘milking’. Although often benign and without symptoms, myocardial bridging can lead to serious and even fatal complications. We report the case of a woman who came to us with non-radiating retrosternal pain, which occurred on her morning commute and sometimes in the evening, had been intermittent for over a year and was becoming more frequent and intense. A coronary angiogram was performed showing opacification of both coronary arteries via a femoral access, identifying a significant myocardial bridge involving the proximal middle portion of the anterior interventricular artery, with systolic compression of 50 to 70% and the absence of significant arteriosclerotic lesions in the right coronary artery. The patient was classified as Schwarz 1 and started on antiplatelet therapy (75 mg/day aspirin), calcium channel blocker (10 mg/day amlodipine) for hypertension, with emphasis on lifestyle modifications including weight loss and regular exercise.
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References
- Rousseau A-F, Mievis E. L’image du mois. Sous le pont myocardique coule la coronaire. Rev Médicale Liège 2003;58.
- Choudhary R, Gautam D, Bagarhatta R, Pathak V. Acute Infero-Lateral MI after Blood Donation in a Patient of Myocardial Bridge: a Case Report of Rare Co-Occurrence. Am J Med Case Rep 2014;2:143–5. https://doi.org/10.12691/ajmcr-2-7-4.
- Ferreira AG, Trotter SE, König B, Décourt LV, Fox K, Olsen EG. Myocardial bridges: morphological and functional aspects. Br Heart J 1991;66:364–7. https://doi.org/10.1136/hrt.66.5.364.
- Reyman HC. Disertatis de vasis cordis propis. Bobl Anat 2, 368, 1737.
- Polacek P. [Myocardial bundles bridging the course of the coronary arteries]. Anat Anz 1959;106:386–95.
- Bezerra AJC, Prates JC, DiDio LJA. Incidence and clinical significance of bridges of myocardium over the coronary arteries and their branches. Surg Radiol Anat 1987;9:273–80. https://doi.org/10.1007/BF02105296.
- Grondin P, Bourassa MG, Noble J, Petitclerc R, Dydra I. Successful course after supraarterial myotomy for myocardial bridging and milking effect of the left anterior descending artery. Ann Thorac Surg 1977;24:422–9. https://doi.org/10.1016/s0003-4975(10)63435-2.
- Garg S, Brodison A, Chauhan A. Occlusive systolic bridging of circumflex artery. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv 2000;51:477–8. https://doi.org/10.1002/1522-726x(200012)51:4<477::aid-ccd22>3.0.co;2-k.
- Camara M, Cisse I, Camara T, Koné AC, Diawara Y, Konaté M, et al. Apport de l’Angioscanner dans la Prise en Charge des Douleurs Thoraciques non Traumatiques au Centre Hospitalier Mère-Enfant «Le Luxembourg». Health Sci Dis 2021;22. https://doi.org/10.5281/hsd.v22i2.2535.
- Ellenga Mbolla BF. GRIEU P. Sen D. Ablani N. Interet du scanner cardiaque dans le diagnostic du pont myocardique chez un sujet presentant des douleurs thoracique (cas Clinique). JAMA 2016; volume 8 (numero 1).
- Tauth J, Sullebarger T. Myocardial infarction associated with myocardial bridging: case history and review of the literature. Cathet Cardiovasc Diagn 1997;40:364–7. https://doi.org/10.1002/(sici)1097 0304(199704)40:4<364::aid-ccd9>3.0.co;2-7.
- Boudoulas KD, Kilic A. Epicardial fibrosis mimicking a myocardial bridge. Interact Cardiovasc Thorac Surg 2014;19:336–8. https://doi.org/10.1093/icvts/ivu122.
- A B, V M, Jm A. Coronary stenting for symptomatic myocardial bridging. Heart Br Card Soc 1998;80. https://doi.org/10.1136/hrt.80.1.102.
- Vidal V, Leguerrier A, Bourdonnec C, Langella B, Rioux C, Logeais Y. Aspects angiographiques et chirurgicaux des ponts musculaires compressifs et des trajets intramyocardiques de l’artère interventriculaire antérieure (à propos de 12 cas). Surg Radiol Anat 1988;10:7–11. https://doi.org/10.1007/BF02199689.
- J G, A J, A R, M A, D B, F L, et al. New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler. Eur Heart J 1999;20. https://doi.org/10.1053/euhj.1999.1661.
- Bd P, F K, Ir S. Normalisation of abnormal coronary fractional flow reserve associated with myocardial bridging using an intracoronary stent. Heart Br Card Soc 2000;83. https://doi.org/10.1136/heart.83.6.705.
References
Rousseau A-F, Mievis E. L’image du mois. Sous le pont myocardique coule la coronaire. Rev Médicale Liège 2003;58.
Choudhary R, Gautam D, Bagarhatta R, Pathak V. Acute Infero-Lateral MI after Blood Donation in a Patient of Myocardial Bridge: a Case Report of Rare Co-Occurrence. Am J Med Case Rep 2014;2:143–5. https://doi.org/10.12691/ajmcr-2-7-4.
Ferreira AG, Trotter SE, König B, Décourt LV, Fox K, Olsen EG. Myocardial bridges: morphological and functional aspects. Br Heart J 1991;66:364–7. https://doi.org/10.1136/hrt.66.5.364.
Reyman HC. Disertatis de vasis cordis propis. Bobl Anat 2, 368, 1737.
Polacek P. [Myocardial bundles bridging the course of the coronary arteries]. Anat Anz 1959;106:386–95.
Bezerra AJC, Prates JC, DiDio LJA. Incidence and clinical significance of bridges of myocardium over the coronary arteries and their branches. Surg Radiol Anat 1987;9:273–80. https://doi.org/10.1007/BF02105296.
Grondin P, Bourassa MG, Noble J, Petitclerc R, Dydra I. Successful course after supraarterial myotomy for myocardial bridging and milking effect of the left anterior descending artery. Ann Thorac Surg 1977;24:422–9. https://doi.org/10.1016/s0003-4975(10)63435-2.
Garg S, Brodison A, Chauhan A. Occlusive systolic bridging of circumflex artery. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv 2000;51:477–8. https://doi.org/10.1002/1522-726x(200012)51:4<477::aid-ccd22>3.0.co;2-k.
Camara M, Cisse I, Camara T, Koné AC, Diawara Y, Konaté M, et al. Apport de l’Angioscanner dans la Prise en Charge des Douleurs Thoraciques non Traumatiques au Centre Hospitalier Mère-Enfant «Le Luxembourg». Health Sci Dis 2021;22. https://doi.org/10.5281/hsd.v22i2.2535.
Ellenga Mbolla BF. GRIEU P. Sen D. Ablani N. Interet du scanner cardiaque dans le diagnostic du pont myocardique chez un sujet presentant des douleurs thoracique (cas Clinique). JAMA 2016; volume 8 (numero 1).
Tauth J, Sullebarger T. Myocardial infarction associated with myocardial bridging: case history and review of the literature. Cathet Cardiovasc Diagn 1997;40:364–7. https://doi.org/10.1002/(sici)1097 0304(199704)40:4<364::aid-ccd9>3.0.co;2-7.
Boudoulas KD, Kilic A. Epicardial fibrosis mimicking a myocardial bridge. Interact Cardiovasc Thorac Surg 2014;19:336–8. https://doi.org/10.1093/icvts/ivu122.
A B, V M, Jm A. Coronary stenting for symptomatic myocardial bridging. Heart Br Card Soc 1998;80. https://doi.org/10.1136/hrt.80.1.102.
Vidal V, Leguerrier A, Bourdonnec C, Langella B, Rioux C, Logeais Y. Aspects angiographiques et chirurgicaux des ponts musculaires compressifs et des trajets intramyocardiques de l’artère interventriculaire antérieure (à propos de 12 cas). Surg Radiol Anat 1988;10:7–11. https://doi.org/10.1007/BF02199689.
J G, A J, A R, M A, D B, F L, et al. New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler. Eur Heart J 1999;20. https://doi.org/10.1053/euhj.1999.1661.
Bd P, F K, Ir S. Normalisation of abnormal coronary fractional flow reserve associated with myocardial bridging using an intracoronary stent. Heart Br Card Soc 2000;83. https://doi.org/10.1136/heart.83.6.705.