Objective To investigate the clinical characteristics, operative indications, operative methods and operative effect of myocardial bridge(MB). Methods From Oct.1996 to Feb.2007, 34 cases with MB underwent MB operation in Fu Wai Hospital. There were 10 cases with isolated myocardial bridge, 4 complicated with coronary artery heart disease, 15 complicated with heart valve diseases, 3 complicated with hypertrophic obstructive cardiomyopathy, 1 complicated with Marfan’s syndrome and 1 complicated with atrial septal defect. All the 34 cases were diagnosed definitely by coronary angiography. According to cardiac function classification（NYHA）, there were 30 cases in gradeⅡ and 4 cases in gradeⅢ. Thirtytwo cases involved left anterior descending(LAD), 1 involved posterior descending branch(PDB) and 1 involved circumflex(CX), with a length of 1-6 cm respectively. Fifteen cases underwent myotomy on myocardial bridge and 19 cases underwent coronary artery bypass grafting(CAGB). Results Among cases who underwent myotomy on myocardial bridge, there was 1 intraoperative right ventricle perforation which was cured after repair. Among cases who underwent myotomy on myocardial bridge with mitral valve replacement concomitantly, there was 1 death caused by left ventricular rupture. There was no other operative complication. Thirty cases were followed up for 15-124 months. Two cases with isolated MB had angina pectoris after myotomy on myocardial bridge and were controlled by drugs. Among 30 cases with MB, 25 in NYHA gradeⅠ, 2 in gradeⅡ and 3 in gradeⅢ. Conclusion The surgical treatments of myocardial bridge include myotomy on myocardial bridge and CABG, and can be properly chosen according to the length, position of myocardial bridge, and having or not having mural coronary artery proximal atherosclerosis. Both the two treatments can obtain satisfactory clinical outcome.
Objective To review the clinical experience of Heller myotomy for treatment of achalasia through a small thoracotomy. Methods Twenty-five patients with achalasia (9 moderate, 16 severe) underwent Heller myotomy without concomitant antireflux procedure through a small incision. A left thoracotomy was carried out through either the seventh or eighth intercostals space. The length of skin incision was 6 to 8 cm. Results There was no hospital death and severe postoperative complications. The mean operating time was 50 minutes. Mean hospital stay was 10 days. There was one intraoperative perforation and repaired successfully. All patients reported good to excellent relief of dysphagia and no symptom of gastroesophageal reflux after surgery. Eight patients were subsequently studied with a 24-hour esophageal pH monitoring and no evidence of pathologic reflux found. Conclusions Transthoracic Heller myotomy with a small incision is effective and safe method for treatment of achalasia with minimal invasion, quick recovery, less postoperative complication and shorter hospital stay. Proper extent of the myotomy may decrease the risk of subsequent gastroesophageal reflux in the postoperative period.