Prevalencia y características de los puentes miocárdicos en estudios de angiografía coronaria por tomografía computarizada multidetector

Introduccion Los puentes miocardicos (PM) representan una anomalia congenita de las arterias coronarias en la que un segmento de una arteria coronaria principal, de habitual trayecto epicardico, transcurre dentro del miocardio describiendo un curso intramural. Aunque el metodo diagnostico de referencia es la angiografia convencional, existen otras tecnicas invasivas. Con el advenimiento de la angiografia coronaria por tomografia computarizada multidetector (ACTCM) ha surgido una alternativa no invasiva para su evaluacion. Objetivos Evaluar la prevalencia y las caracteristicas de los puentes miocardicos en pacientes examinados con angiografia coronaria por tomografia computarizada multidetector (ACTCM). Material y metodos Se evaluaron en forma consecutiva 452 pacientes con ACTCM de 16 y 64 filas. Los motivos de la solicitud medica incluyeron hallazgos patologicos en estudios de perfusion miocardica, sintomas sugestivos de enfermedad coronaria y pacientes asintomaticos con antecedentes heredofamiliares de enfermedad coronaria. Se determinaron la presencia, la localizacion y las caracteristicas de los PM, los cuales se clasificaron en completos e incompletos segun el grado de tunelizacion de la arteria involucrada. Se evaluo tambien su comportamiento durante la sistole y la diastole. Resultados La prevalencia de PM fue del 35,18%; se identificaron 88 casos de PM completos y 71 incompletos. Dentro del grupo de los PM completos, 6 mostraron compresion sistolica-diastolica, 27 solo compresion sistolica y 55 no mostraron compresion. En el grupo de los PM incompletos no se detectaron casos con compresion arterial. Conclusiones La ACTCM mostro una prevalencia de PM mayor que la esperada en la poblacion en estudio y permitio su clasificacion y la evaluacion de su comportamiento durante las fases del ciclo cardiaco.(AU) Background Myocardial bridging (MB) are congenital defects of the coronary arteries in which a segment of an epicardial artery lies in the myocardium for part of its course. The current gold standard for diagnosing MB is coronary angiography; however other invasive techniques are also useful. Myocardial bridging can also be visualized with the use of novel non-invasive imaging techniques such as multidetector-row computed tomography coronary angiography (MDCT-CA). Objectives To assess the prevalence and characteristics of myocardial bridging in patients undergoing multidetector-row computed tomography coronary angiography (MDCT-CA). Material and Methods A total of 452 consecutive patients were evaluated with 16-row and 64-row MDCT-CA due to the presence of abnormal findings in myocardial perfusion image tests, symptoms suggestive of coronary artery disease, and in asymptomatic patients with a family history of coronary artery disease. The presence of MB, their location and characteristics were analyzed. Myocardial bridging were classified as complete and incomplete bridges with respect to continuity of the myocardium over the tunneled segment of the artery involved. Quantitative measurements of vessel diameter during systole and diastole were evaluated. Results The prevalence of MB was 35.18%; 88 were complete and 71 incomplete. Among complete MB, 6 affected both systole and diastole, 27 presented only systolic compression and 55 showed no compression. Incomplete MB showed absence of arterial compression. Conclusions Multidetector-row computed tomography coronary angiography detected a higher prevalence of MB in the study population and allowed to classify them and to assess their functional aspects throughout the cardiac cycle.(AU)