transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2022-9-5-20-32transmed-725Research ArticleСЕРДЕЧНО-СОСУДИСТЫЕ ЗАБОЛЕВАНИЯCARDIOVASCULAR MEDICINEСовременное состояние проблемы миокардиальных «мостиков»The current state of the problem of myocardial bridgeshttps://orcid.org/0000-0002-9232-6459МирзоевН. Т.MirzoevN. T.

Мирзоев Никита Тагирович, слушатель ординатуры по специальности «Терапия»

SPIN-код: 9826-5624

ул. Академика Лебедева, д. 6, Санкт-Петербург, 194044

Nikita T. Mirzoev, resident, therapy department

 Saint Petersburg

mirsoev@mail.ruhttps://orcid.org/0000-0002-3141-7111ШуленинК. С.ShuleninK. S.

Шуленин Константин Сергеевич, д.м.н., доцент, заместитель начальника кафедры военно-морской терапии

SPIN-код: 8476-1052

Санкт-Петербург

Konstantin S. Shulenin, MD, PhD, DSс, Associate Professor, Deputy Head of the Department of Naval therapy

 Saint Petersburg

shulenink@mail.ruhttps://orcid.org/0000-0002-6489-9938КутелевГ. Г.KutelevG. G.

Кутелев Геннадий Геннадьевич, к.м.н., старший преподаватель кафедры военно-морской терапии

SPIN-код: 5139-8511

Санкт-Петербург

Gennady G. Kutelev, MD, PhD, Senior Lecturer, department of Naval therapy

 Saint Petersburg

gena08@yandex.ruhttps://orcid.org/0000-0003-1363-6860ЧеркашинД. В.CherkashinD. V.

Черкашин Дмитрий Викторович, д.м.н., профессор, заслуженный врач РФ, начальник кафедры военно-морской терапии

SPIN-код: 2781-9507

Санкт-Петербург

Dmitry V. Cherkashin, MD, PhD, DSс, Professor, Honored Doctor of the Russian Federation, Head of the Department of Naval therapy

 Saint Petersburg

cherkashin_dmitr@mail.ruhttps://orcid.org/0000-0003-2310-4518ИвановВ. В.IvanovV. V.

Иванов Владимир Владимирович, к.м.н., начальник пульмонологического отделения 1-й клиники (терапии усовершенствования врачей)

SPIN-код: 1736-8285

Санкт-Петербург

Vladimir V. Ivanov, MD, PhD, Head of the Pulmonology Department of the 1st Therapeutic Clinic of Postgraduate Education

 Saint Petersburg

sea-89@yandex.ruhttps://orcid.org/0000-0002-1569-2180МеньковИ. А.MenkovI. A.

Меньков Игорь Анатольевич, к.м.н., врач-рентгенолог, заведующий отделением компьютерной томографии кафедры рентгенологии и радиологии с курсом ультразвуковой диагностики

SPIN-код: 3868-3635

Санкт-Петербург

Igor A. Menkov, MD, PhD, radiologist, Head of the Computed Tomography Department of the Department of Roentgenology and Radiology with the course of ultrasound diagnosis

 Saint Petersburg

i.menkov@gmail.comФедеральное государственное бюджетное военное образовательное учреждение высшего образования «Военно-медицинская академия имени С. М. Кирова» Министерства обороны Российской ФедерацииРоссияS. M. Kirov Military Medical AcademyRussian Federation202228122022952032Copyright © Мирзоев Н.Т., Шуленин К.С., Кутелев Г.Г., Черкашин Д.В., Иванов В.В., Меньков И.А., 20232023Мирзоев Н.Т., Шуленин К.С., Кутелев Г.Г., Черкашин Д.В., Иванов В.В., Меньков И.А.Mirzoev N.T., Shulenin K.S., Kutelev G.G., Cherkashin D.V., Ivanov V.V., Menkov I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/725

Миокардиальный «мостик» (ММ) - врожденная аномалия развития коронарных артерий (КА), при которой эпикардиальный сегмент сосуда проходит в толще миокарда. При данной аномалии могут поражаться любые КА, однако наиболее часто она затрагивает переднюю межжелудочковую артерию. Большинство ММ ассоциировано с бессимптомным течением, однако в доступной научной литературе, посвященной проблеме ММ, имеется большое число публикаций, описывающих и доказывающих связь между ММ и симптомами ишемии миокарда, включая случаи развития острого коронарного синдрома и внезапной сердечной смерти.

В настоящем обзоре авторами обобщены и представлены современные данные о частоте распространения, патофизиологических механизмах, анатомо-функциональной и клинической оценке, а также лечению ММ. У пациентов с симптомными ММ медикаментозное лечение обычно является эффективной терапией. При ее неэффективности должна проводиться комплексная анатомическая и функциональная оценка ММ для выбора наиболее безопасной и эффективной методики реваскуляризации. Чрескожное коронарное вмешательство с помощью стентов нового поколения в настоящее время рассматривается как стратегия лечения ММ. Аортокоронарное шунтирование проводится при глубоком залегании туннельного сегмента КА под миокардом или при осложнениях, связанных со стентированием. Миотомия является высокоэффективным методом лечения пациентов с ММ при поверхностном залегании интрамиокардиального сегмента КА и выполнении операции в условиях специализированных кардиохирургических центров. 

Отсутствие общепринятых рекомендаций, очевидно, делает необходимым проведение дальнейших исследований в области рассматриваемой проблемы для разработки и валидизации единых алгоритмов по диагностике и лечению пациентов с ММ. В настоящем обзоре авторами обобщены и представлены современные данные о частоте распространения, патофизиологических механизмах, анатомо-функциональной и клинической оценке, а также лечению ММ.

Myocardial bridge (MB) a congenital developmental anomaly of the coronary arteries (CA), in which the epicardial segment of the vessel passes under the myocardium. With this anomaly, any CA can be affected, but most often it is located in the left anterior descending artery. Most MB is associated with an asymptomatic course, however, in the available scientific literature about the problem of MB, there are a lot of publications describing and proving the relationship between MB and symptoms of myocardial ischemia, including cases of acute coronary syndrome and sudden cardiac death.  

In this review the authors summarize and present modern data of the frequency, pathophysiological mechanisms, anatomical, functional and clinical evaluation, as well as treatment of MB. Medical treatment is usually an effective therapy in patients with symptomatic MB. If it is ineffective, a comprehensive anatomical and functional assessment of the MM should be carried out to select the safest and most effective revascularization technique. Percutaneous coronary intervention with new generation stent, coronary artery bypass grafting and myotomy are currently being considered as a treatment strategy for MB.  

The lack of generally accepted recommendations obviously makes it necessary to conduct further research in the field of the problem under consideration in order to develop and validate unified algorithms for the diagnosis and treatment of patients with MB. 

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