Mengenal Myocardial Bridging: Saluran di dalam Otot Jantung

Myocardial bridging (MB) adalah kondisi bawaan di mana segmen arteri koroner terjepit di dalam miokardium. Kelainan ini dapat menyebabkan berbagai gejala dan komplikasi jantung, termasuk iskemia miokard, aritmia, dan bahkan kematian mendadak. Diagnosis dan penanganan MB memerlukan pendekatan komprehensif yang menggabungkan evaluasi klinis, teknik pencitraan non-invasif, dan prosedur invasif.

Dalam hal diagnosis, beberapa metode dapat digunakan. Metode invasif seperti ultrasonografi intravaskular (IVUS) dan angiografi koroner menawarkan sensitivitas dan spesifisitas tinggi dalam mendeteksi MB. IVUS memungkinkan visualisasi detail dari arteri koroner dan derajat myocardial bridging, sedangkan angiografi koroner memberikan gambaran jelas tentang dinamika aliran darah dan penyempitan yang terkait. Di sisi lain, teknik non-invasif seperti ultrasonografi Doppler, computed tomography (CT) multislice, dan magnetic resonance imaging (MRI) adalah alat berharga karena sifatnya yang non-invasif, hemat biaya, dan akurasi diagnostik yang tinggi.

Gejala yang terkait dengan MB sering kali termasuk angina pektoris, yang terjadi karena terjepitnya segmen yang terhubung selama sistol. Modalitas diagnostik tambahan seperti elektrokardiografi (EKG), tes stres, echocardiografi, dan computed tomography angiography (CTA) jantung memainkan peran penting dalam mengkonfirmasi keberadaan MB dan mengevaluasi signifikansinya secara klinis. Tes ini membantu mengevaluasi derajat iskemia miokard dan memandu strategi penanganan.

Penanganan MB bertujuan untuk meredakan gejala dan mencegah hasil yang buruk. Pendekatan konservatif, termasuk modifikasi gaya hidup, farmakoterapi, dan manajemen faktor risiko, sering digunakan untuk pasien dengan MB ringan atau tanpa gejala. Intervensi ini mungkin melibatkan penggunaan agen antiplatelet, penyekat beta, dan penyekat kanal kalsium untuk meredakan gejala dan meningkatkan aliran darah. Tindak lanjut dan pemantauan secara teratur terhadap kondisi pasien penting untuk memastikan penanganan yang optimal.

Pada kasus di mana pasien mengalami gejala persisten atau iskemia miokard yang signifikan, intervensi terapeutik yang lebih agresif mungkin diperlukan. Intervensi koroner perkutan (PCI) dengan pemasangan stent dapat dilakukan untuk mengurangi tekanan pada arteri koroner dan memulihkan aliran darah. Miotomi bedah, yang melibatkan pemotongan jembatan miokard, merupakan pilihan lain untuk mengurangi tekanan dan meningkatkan aliran darah.

Pemilihan modalitas pengobatan tergantung pada berbagai faktor, termasuk keparahan gejala, keberadaan faktor risiko kardiovaskular yang terkait, dan derajat iskemia miokard. Pengambilan keputusan yang dipersonalisasi penting dalam memilih pendekatan pengobatan yang paling sesuai untuk setiap pasien.

Penting untuk dicatat bahwa MB adalah gangguan jantung yang dapat diobati, dan diagnosis dini dan penanganan yang tepat sangat penting dalam mengurangi morbiditas dan mortalitas yang terkait dengan kondisi ini. Upaya kolaboratif antara dokter, peneliti, dan profesional kesehatan diperlukan untuk meningkatkan pengambilan keputusan klinis, meningkatkan hasil pasien, dan memajukan pemahaman kita tentang myocardial bridging.

Sebagai kesimpulan, myocardial bridging adalah kelainan kongenital arteri koroner di mana segmen arteri terjepit di dalam miokardium. Ini dapat menyebabkan gejala dan komplikasi jantung yang signifikan. Diagnosis MB dapat dilakukan dengan menggunakan berbagai modalitas pencitraan, dan pendekatan penanganan tergantung pada keparahan gejala dan komplikasinya <!--[if supportFields]>ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.jacc.2021.09.859","ISSN":"15583597","PMID":"34823663","abstract":"Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of the epicardial coronary artery traverses through the myocardium for a portion of its length. The muscle overlying the artery is termed a myocardial bridge, and the intramyocardial segment is referred to as a tunneled artery. MB can occur in any coronary artery, although is most commonly seen in the left anterior descending artery. 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Referensi:

<!--[if supportFields]>ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY <![endif]-->Sternheim D, Power DA, Samtani R, Kini A, Fuster V, Sharma S. Myocardial Bridging:Diagnosis, Functional Assessment, and Management: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;78(22):2196–212.

Evbayekha EO, Nwogwugwu E, Olawoye A, Bolaji K, Adeosun AA, Ajibowo AO, et al. A Comprehensive Review of Myocardial Bridging: Exploring Diagnostic and Treatment Modalities. Cureus. 2023;15(8).

Ciliberti G, Laborante R, Di Francesco M, Restivo A, Rizzo G, Galli M, et al. Comprehensive functional and anatomic assessment of myocardial bridging: Unlocking the Gordian Knot. Front Cardiovasc Med. 2022;9(November):1–13.

Sumber gambar: https://www.freepik.com/free-photo/young-medicine-student-doing-their-practice-hospital_16408942.htm#query=Myocardial Bridging&position=2&from_view=search&track=ais&uuid=fd6758ee-1f4a-4790-98ac-b25b569a5235

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