Influence of the myocardial bridging phenomenon on the myocardial structure and the coronary arteries wall structure changes

Jelena Tomanovic-Kokovic, Gordana Teofilovski-Parapid, Mirjana Oklobdzija, Vladimir Kanjuh, Slobodan Kovacevic, Biljana Parapid, Vladimir Kokovic
2006 Vojnosanitetski Pregled  
Medicinski fakultet, *Institut za ginekologiju i akušerstvo, † Institut za anatomiju, ‡ Institut za patologiju, ║ Institut za sudsku medicinu; Stomatološki fakultet, § Klinika za oralnu hirurgiju, Beograd Apstrakt Uvod/Cilj. Pojava intramiokardnog poniranja koronarnih arterija je fenomen koji je u velikom broju slučajeva uzrok niza funkcionalnih poremećaja srčane aktivnosti i jedan od etiopatogenetskih faktora aterogeneze koronarnih arterija. Cilj studije bila je analiza stepena uticaja
more » ... ena uticaja miokardnih premošćenja koronarnih arterija, na morfološke promene strukture, kako samog zida premošćene arterije, tako i okolnog miokarda. Metode. U analiziranom petogodišnjem periodu, na obdukcionom materijalu, utvrđeno je da od 575 smrtnih slučajeva sa uputnom dijagnozom mors naturalis kod 27 (4,70%) je postojalo koronarno miokardno premošćenje. U svim slučajevima kod kojih je u toku obdukcije utvrđeno prisustvo miokardnog mosta nad arterijskim koronarnim sudom uzimani su isečci za mikroskopsku verifikaciju i istraživanja. Rezultati. Pojava ciklično ponavljane kompromitacije koronarne perfuzije podstiče patogenezu ateromatoznih promena na zidu koronarnih arterija, na šta je ukazivao nalaz ateroskleroze različitog stepena čak u 88,89% slučajeva. Poremećena cirkulacija vodila je degeneraciji miokarda i to fibroznoj, koju smo našli u 88,89% i masnoj degeneraciji, koja je bila prisutna kod 66,67% slučajeva. Zaključak. Dobijeni rezultati nas navode da pojavu miokardnog premošćenja koronarnih arterija i/ili njihovih grana posmatramo kao patološku i potencijalno opasnu, pa čak i letalnu pojavu koja zaslužuje znatniju kliničku evaluaciju. Ključne reči: koronarni krvni sudovi; miokard; autopsija; mikroskopija; arterioskleroza, koronarna. Abstract Background/Aim. Our research was performed to evaluate the influences of the myocardial bridgings of coronary arteries on the myocardial and coronary arteries wall structure chages, that could be a reason for multiple heart malfunctions. Methods. We analyzed the autopsy material, collected during a five-years period, and especially the group of 575 cases with the major aim to diagnose mors naturalis. In all cases with the presence of myocardial bridge over the arterial coronary wall revealed at autopsy, samples were taken for microscopic verification and examination. Results. We found myocardial bridges over the coronary arteries or their major branches in 27 of the cases (4.70%). We believe that myocardial bridges compromise coronary perfusion by cyclic compression of the overbridged vessels, and that it could be the initial factor in the pathogenesis of arteriosclerotic degeneration processes on the coronary artery wall. We found different grades of arteriosclerotic changes in 88.89% of the cases, as well as fibrosis of myocardium in 88.89% and lipomatosis in 66.67% of the cases with the present myocardial bridges. Conclusion. Our results suggested that myocardial bridging of coronary arteries and/or their branches was the pathological and even lethal phenomenon that deserves more intensive clinical evaluation.
doi:10.2298/vsp0602148t pmid:16502989 fatcat:ydaumkcqpvgzdmsnvactahxc2m