Original Articles Korean Circulation J 2000;30 7 : 심근교환자의임상적및관상동맥조영술특성과 장기적임상경과 김원 1 정명호 2 김계훈 1 박종철 1 김건형 1 이승욱 1 김남호 1 안영근 1 조정관 1 박종춘 2 강정채

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1 Original Articles Korean Circulation J 2000;307: 심근교환자의임상적및관상동맥조영술특성과 장기적임상경과 김원 1 정명호 2 김계훈 1 박종철 1 김건형 1 이승욱 1 김남호 1 안영근 1 조정관 1 박종춘 2 강정채 2 Clinical and Angiographic Characteristics, and Long-Term Clinical Follow-up of Myocardial Bridge Weon Kim, MD 1, Myung Ho Jeong, MD 2, Kye Hun Kim, MD 1, Jong Cheol Park, MD 1, Kun Hyung Kim, MD 1, Seung Wook Lee, MD 1, Nam Ho Kim, MD 1, Young Keun Ahn, MD 1, Jeong Gwan Cho, MD 2, Jong Chun Park, MD 2 and Jung Chaee Kang, MD 2 1 The Heart Center, Chonnam National University Hospital, 2 Department of Internal Medicine, The Research Institute of Medical Sciences, Kwangju, Korea ABSTRACT BackgroundAn anatomical anomaly in which myocardial fibers make the bridge over the epicardial coronary artery is called myocardial bridge. Its clinical significance has been emphasized, because some serious cardiac diseases such as myocardial infarction or sudden cardiac death can be developed. MethodsForty five patients 30 male and 15 female, years out of 4,694 patients who underwent diagnostic coronary angiography and diagnosed as myocardial bridge at Chonnam National University Hospital between January 1996 and March 1999, were analyzed retrospectively. ResultsThe incidence of myocardial bridge on the coronary angiography was 0.95%. Middle left anterior descending artery was most common 36 patients, 80% in the location. Associated stenoses were observed in 5 cases 11.1%. For the pharmacological treatment, calcium antagonist 26 cases, 57.7%, -blocker 23 cases, 51.1% and nitrate 9 cases, 20.0% were used. Single regimen was used in % cases, dual drugs were administered in % and triple drugs in 2 4.4% cases. During clinical follow-up of 40 patients for 1411 months 440 months, no major cardiac events developed in all patients. ConclusionThe incidence of the myocardial bridge is 0.95% and middle left anterior descending artery was the most common site. Long-term prognosis is relatively good in almost patients with myocardial bridge. Korean Circulation J 2000;307: KEY WORDSMyocardial bridge Coronary angiograpy. 서 론 819

2 대상및방법 대상 방법 통계 결과 관상동맥조영술상심근교의유병률 대상자의임상적특징 820 Korean Circulation J 2000;307:

환으로서는 비후성 심근증이 1예가 있었다. 관상동맥 반하였는데 그 중 3예는 심근교 혈관부위에 협착이 있 질환의 위험인자는 흡연(17예, 37.7%), 고혈압(12예, 었고 2예는 심근교가 아닌 혈관부위에 협착이 있었다 26.6%) 등이 고콜레스테롤혈증(3예, 6.6%), 당뇨병(4 (Table 2). 예, 8.8%) 등보다 많았다(Table 1).

3 환으로서는 비후성 심근증이 1예가 있었다. 관상동맥 반하였는데 그 중 3예는 심근교 혈관부위에 협착이 있 질환의 위험인자는 흡연(17예, 37.7%), 고혈압(12예, 었고 2예는 심근교가 아닌 혈관부위에 협착이 있었다 26.6%) 등이 고콜레스테롤혈증(3예, 6.6%), 당뇨병(4 (Table 2). 예, 8.8%) 등보다 많았다(Table 1). 심장검사 소견 관상동맥 조영술 시행 전에 17예(37.7%)에서 운동 부하심전도를 시행하여 그 중 8예(47.7%)에서 양성을 나타냈으며 15예(33.3%)에서 Thallium SPECT을 실 시하여 그 중 12예(80%)에서 심근관류결손을 보였다. 관상동맥 조영술 소견 관상동맥 조영술 소견에서 심근교를 보인 표적 혈관 A 의 위치는 중위부 좌전하행지 36예(80%), 하위부 좌전 하행지 6예(13%), 중,하위부 좌전하행지 1예(2.2%), 좌 회선지 2예(4.4%)로서 좌전하행지에만 43예(95.5%)의 분포를 보였다(Fig. 2). 5예(11.1%)에서 협착병변을 동 B Fig. 1. Distribution of age and sex in patients with myocardial bridge. Fig. 2. A case of myocardial bridge. Left coronary angiogram taken at right anterior oblique view revealed pronounced compression in the middle of left anterior descending artery (LAD) during systole (A) and no compression of LAD during diastole (B). Table 1. Clinical characteristics of the patients No Age(years) % Table 2. Angiographic characteristics of the patients No 48±11.0 % Bridged artery Sex Male Female Clinical diagnosis Left anterior descending artery Middle Distal Middle and distal Left circumflex artery Unstable angina Right coronary artery 0 0 Acute myocardial infarction In bridged artery In anoth er artery Atypical chest pain Stable angina Risk factors Smoking Hypertension Fixed stenosis Systolic narrowing of lumen Hypercholesterolemia <50% Diabetes mellitus %

4 약물치료 추적관찰 822 Table 3. Medical therapy in patients with myocardial bridges No % Antianginal therapy Calcium blocker Beta blocker Nitrate Monotherapy Dualtherapy Tripletherapy Nitrates 9 with calcium blocker 4 with beta blocker 5 Table 4. Long term follow-up of patients with systolic compression less than 50% Group A or more than 50% Group B No pain % 심근교의빈도 고 Group A Group B 안 Total Atypical chest pain % Effort-induced chest pain % Chest pain at rest % Myocardial infarction % Cardiac death % Total number % PNS Korean Circulation J 2000;307:

5 관동맥조영술상이환부위와특징 비후성심근증과연관성 심근교와심근허혈 823

6 임상적의의및진단 824 치료및임상경과 Korean Circulation J 2000;307:

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노영남 Purpose: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding