关键词: 心肌桥, 冠状动脉, 病理生理机制, 诊断, 治疗

Abstract: Myocardial bridging(MB)is a congenital coronary artery running abnormality, which refers to the anatomical phenomenon that part of the coronary artery should normally run in the pericardium instead “grows”below the myocardial fiber. MB compression during coronary systolic may cause myocardial ischemia, coronary spasm, arrhythmia, and even sudden death. This article provides an in-depth review of the latest research progress of MB in terms of epidemiology, clinical manifestations, disease physiology, evaluation methods and treatment. Among the three commonly used MB detection methods of CCTA, CAG and IVUS, the detection rate of CAG is the lowest compared with the autopsy research results. MB patients are usually asymptomatic. In clinical diagnosis and treatment, it is often difficult to judge whether the patient's symptoms are related to MB. When identifying the cause, it is necessary to comprehensively consider whether the symptoms are directly related to MB or whether the complications such as coronary spasm and atherosclerotic coronary artery disease caused by MB are indirectly related to MB. MB may cause endothelial dysfunction by changing the hemodynamics of the coronary artery as a whole. There are two types of MB evaluation methods: invasive and non-invasive examination. The former includes coronary angiography, intravascular ultrasound, optical coherence tomography(OCT), coronary artery doppler FFR and iFR, etc. The latter includes coronary artery coronary computed tomography angiography(CCTA), composite echocardiography, myocardial perfusion imaging and electrocardiography, etc. Beta receptor blockers and calcium channel blockers are the first choice for drug treatment of patients with symptomatic MB, which relieve symptoms by reducing myocardial contractility. For drug-intractable MB, interventional treatment and MB lysis can be used, but their long-term efficacy and safety still need to be verified through large-scale research. In the future, MB-related research should focus on the physiological mechanism of the disease and establish a more comprehensive and scientific clinical typing system; multi-center research should be carried out to improve the shortcoming of the overall sample size of relevant research. It should be combined with the technical advantages in the fields of cardiovascular diseases, imaging, biological engineering and artificial intelligence, through the anatomy, function of MB The integration of energy, treatment and prognosis data improves the clinical management level of MB-related diseases.

Key words: myocardial bridging, coronary artery, pathophysiological mechanisms, diagnosis, treatment