vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2020-17-1-38-48vestim-658Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEМиокардиальные мостики и обструктивный атеросклероз венечных артерийMyocardial bridges and obstructive coronary atherosclerosisКабакС. Л.KabakS. L.

Кабак Сергей Львович – доктор медицинских   наук, профессор, заведующий кафедрой

пр. Дзержинского, 83, 220116, г. Минск

 

Sergey L. Kabak – D. Sc. (Med.), Professor, Head of the Department

 

kabakmorph@gmail.comМельниченкоЮ. М.MelnichenkoYu. M.

Мельниченко Юлия Михайловна – кандидат медицинских наук, доцент

пр. Дзержинского, 83, 220116, г. Минск

 

Yuliya M. Melnichenko – Ph. D. (Med.), Assistant Professor

83, Dzerzhinski Ave., 220116, Minsk

mjm1980@yandex.ruГордионокД. М.GordionokD. M.

Гордионок Дмитрий Михайлович – ассистент

пр. Дзержинского, 83, 220116, г. Минск

 

Dmitry M. Gordionok – Assistant

83, Dzerzhinski Ave., 220116, Minsk

delmicom11@gmail.comКаленчицТ. И.KalenchicT. I.

Каленчиц Тамара Ивановна – кандидат медицинских наук, доцент

пр. Дзержинского, 83, 220116, г. Минск

 

Tamara I. Kalenchic – Ph. D. (Med.), Assistant Professor

83, Dzerzhinski Ave., 220116, Minsk

kalenchic@gmail.comГайдельИ. К.HaidzelI. K.

Гайдель Ирина Казимировна – врач-рентгенолог

ул. Розы Люксембург, 110 Б, 220036, г. Минск

 

Irina K. Haidzel – Radiologist

110 B, R. Luxemburg Str., 220036, Minsk

irena.heidel@gmail.comЮдинаО. А.YudinaO. A.

Юдина Ольга Анатольевна – кандидат медицинских наук, доцент, врач-патологоанатом

Ждановичский с/с, 81/5, 223028, Ждановичи, Минский р-н

Olga А. Yudina – Ph. D. (Med.), Assistant Professor, Pathologist

81/5, Zhdanovichy s/s, 223028, Zhdanovichy, Minsk Region

o.yudina@inbox.ruБелорусский государственный медицинский университетBelarusБелорусский государственный медицинский университетBelarusian State Medical UniversityРеспубликанский научно-практический центр «Кардиология»Republican Scientific and Practical Center “Cardiology”«Республиканский клинический медицинский центр» Управления делами Президента Республики Беларусь“Republican Clinical Medical Center” of the Office of the President of the Republic of Belarus2020180320201713848Copyright © Кабак С.Л., Мельниченко Ю.М., Гордионок Д.М., Каленчиц Т.И., Гайдель И.К., Юдина О.А., 20202020Кабак С.Л., Мельниченко Ю.М., Гордионок Д.М., Каленчиц Т.И., Гайдель И.К., Юдина О.А.Kabak S.L., Melnichenko Y.M., Gordionok D.M., Kalenchic T.I., Haidzel I.K., Yudina O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/658

Миокардиальный мостик (ММ) – врожденная аномалия развития, при которой сегмент венечной артерии окружен миокардом. Цель исследования – установить место локализации ММ и выраженность атеросклеротического поражения венечных артерий у пациентов с симптомами ишемической болезни сердца и у лиц – потенциальных доноров сердца для трансплантации. Изучены данные мультиспиральной компьютерной томографии (КТ) венечных артерий с контрастированием у пациентов, находившихся на лечении в РНПЦ «Кардиология» в 2016–2018 гг. Исследовано 324 сердца трупных доноров, не использованные для ортотопической трансплантации. По данным аутопсии и КТ-коронарографии, ММ локализуются главным образом в бассейне передней межжелудочковой ветви левой коронарной артерии (ЛКА). В 7,4 % случаев ММ имели другую локализацию. Они были обнаружены в области дистального отдела промежуточной ветви ЛКА, в задней боковой ветви, правой коронарной артерии, первой диагональной артерии, а также по ходу ветви тупого края и огибающей ветви ЛКА. В 36 % случаев, учитывая протяженность туннелированного сегмента артерии и глубину его залегания, выявленные мостики можно рассматривать как гемодинамически значимые. При микроскопическом исследовании в туннелированном фрагменте венечных артерий в 4,9 % случаев обнаружены начальные признаки поражения сосудистой стенки в виде фиброзно-мышечной дисплазии и липидоза. По результатам КТ-коронарографии не установлено причинно-следственной связи между присутствием ММ и атеросклерозом в сегментах венечных артерий, расположенных субэпикардиально.

The myocardial bridge (MB) is a congenital anomaly, in which a segment of a coronary artery courses through the myocardium. The aim of the study was to establish the location of myocardial bridges and the severity of atherosclerotic lesions of the coronary arteries in patients with coronary heart disease symptoms and in individuals who are the potential heart donors for transplantation. The data of the multislice computed tomography coronary angiography of the patients of the Republican Scientific and Practical Centre “Cardiology” from 2016 to 2018 were included in this study. 324 hearts of the deceased donors, which had not been used for orthotopic transplantation, were studied. According to the autopsy and the CT coronary angiography, the myocardial bridges were localized mainly in the left anterior descending artery of the left coronary artery (LCA). In 7.4 % of cases, MBs were found in a distal portion of the intermediate branch of LCA, in the left postero-lateral branch, in the right coronary artery, in the first diagonal artery, as well as along the obtuse marginal artery and the left circumflex coronary artery. In 36 % of cases, the identified bridges were considered as hemodynamically significant with regard to the length of the tunneled artery segment and its depth. Microscopic examination of the tunneled fragments of the coronary arteries in 4.9 % of cases showed the initial signs of damage of the vessel wall in the form of fibromuscular dysplasia and lipidosis. According to the CT coronary angiography results, no causal relationship has been established between the presence of MBs and atherosclerosis in the subepicardial segments of the coronary arteries.

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The authors declare that there are no conflicts of interest present.