cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2026-41-3-45-52cardiotomsk-3272Research ArticleОБЗОРЫREVIEWSМиокардиальные мостики у детей: диагностические методы и терапевтические подходы (обзор литературы)Myocardial bridges in children: diagnostic methods and therapeutic approaches (literature review)https://orcid.org/0000-0002-3947-4903ДжаффароваО. Ю.DzhaffarovaO. Yu.

Джаффарова Ольга Юрьевна - канд. мед. наук, старший научный сотрудник, отделение детской кардиологии, НИИ кардиологии Томского НИМЦ.

634012, Томск, ул. Киевская, 111а

Olga Yu. Dzhaffarova - Cand. Sci. (Med.), Senior Research Scientist, Department of Pediatric Cardiology, Research Institute of Cardiology, Tomsk NRMC.

111a, Kievskaya str., Tomsk, 634012

oyd@cardio-tomsk.ruhttps://orcid.org/0009-0004-7604-6846СозиноваТ. А.SozinovaT. A.

Созинова Татьяна Алексеевна - младший научный сотрудник, отделение детской кардиологии, НИИ кардиологии Томского НИМЦ.

634012, Томск, ул. Киевская, 111а

Tatyana A. Sozinova - Junior Research Scientist, Department of Pediatric Cardiology, Research Institute of Cardiology, Tomsk NRMC.

111a, Kievskaya str., Tomsk, 634012

stm@cardio-tomsk.ruhttps://orcid.org/0000-0002-2056-4060СвинцоваЛ. И.SvintsovaL. I.

Свинцова Лилия Ивановна - д-р мед. наук, заведующий отделением детской кардиологии, НИИ кардиологии Томского НИМЦ.

634012, Томск, ул. Киевская, 111а

Liliya I. Svintsova - Dr. Sci. (Med.), Head of the Department of Pediatric Cardiology, Research Institute of Cardiology, Tomsk NRMC.

111a, Kievskaya str., Tomsk, 634012

lis@cardio-tomsk.ruhttps://orcid.org/0000-0001-8121-8287КартофелеваЕ. О.KartofelevaE. O.

Картофелева Елена Олеговна - младший научный сотрудник, отделение детской кардиологии, НИИ кардиологии Томского НИМЦ.

634012, Томск, ул. Киевская, 111а

Elena O. Kartofеleva - Junior Research Scientist, Department of Pediatric Cardiology, Research Institute of Cardiology, Tomsk NRMC.

111a, Kievskaya str., Tomsk, 634012

keo@cardio-tomsk.ruhttps://orcid.org/0009-0001-5928-949XЯкимоваЕ. В.YakimovaE. V.

Якимова Евгения Валентиновна - младший научный сотрудник, отделение детской кардиологии, НИИ кардиологии Томского НИМЦ.

634012, Томск, ул. Киевская, 111а

Evgenia V. Yakimova - Junior Research Scientist, Department of Pediatric Cardiology, Research Institute of Cardiology, Tomsk NRMC.

111a, Kievskaya str., Tomsk, 634012

Evgenia@cardio-tomsk.ruНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наук (НИИ кардиологии Томского НИМЦ)РоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences (Cardiology Research Institute, TNRMC)Russian Federation2026021020264134552Copyright © Джаффарова О.Ю., Созинова Т.А., Свинцова Л.И., Картофелева Е.О., Якимова Е.В., 20262026Джаффарова О.Ю., Созинова Т.А., Свинцова Л.И., Картофелева Е.О., Якимова Е.В.Dzhaffarova O.Y., Sozinova T.A., Svintsova L.I., Kartofeleva E.O., Yakimova E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/3272Введение

Введение. Миокардиальные мостики (ММ) представляют собой врожденную аномалию коронарных артерий (КА), при которой сегмент сосуда проходит интрамурально. Широкое внедрение мультиспиральной компьютерной томографии-коронарографии (МСКТ-КАГ) привело к росту выявляемости ММ в педиатрической практике, однако отсутствие единых диагностических критериев и протоколов ведения создает клиническую неопределенность.

Цель обзора

Цель обзора: систематизация современных данных о распространенности, патофизиологии, клинической значимости, диагностике и лечении ММ у детей.

Материал и методы

Материал и методы. Проведен анализ литературы по базам данных PubMed, eLibrary за период 1997–2025 гг. с использованием ключевых слов: миокардиальные мостики, дети, коронарные артерии, ишемия миокарда, мультиспиральная компьютерная томография-коронарография.

Результаты и обсуждение

Результаты и обсуждение. Распространенность ММ варьирует от 0,5–16% при КАГ до 22,5–35% при МСКТ-КАГ. Наиболее частая локализация – левая передняя нисходящая артерия (ЛПНА) и ее диагональные ветви. Патофизиологической основой ишемии является динамическая систолическая компрессия, усугубляющаяся при тахикардии. Клинические проявления варьируют от бессимптомного течения до жизнеугрожающих аритмий и внезапной смерти. Диагностический алгоритм включает анатомическую визуализацию (МСКТ-КАГ) и функциональную оценку (стресс-тесты, внутрисосудистое ультразвуковое исследование (ВСУЗИ)). Терапией первой линии являются β-адреноблокаторы; при их неэффективности показана хирургическая миотомия.

Заключение

Заключение. При лечении ММ у детей требуется дифференцированный двухэтапный подход, включающий анатомическую визуализацию с последующей функциональной оценкой. Необходима разработка стратификации риска и клинических рекомендаций на основе проспективных исследований в педиатрической популяции.

Introduction

Introduction. Myocardial bridges (MBs) are a congenital anomaly of the coronary arteries (CAs) in which a vascular segment runs intramurally. The widespread implementation of multislice computed tomography angiography (MSCT-CAG) has led to an increase in the detection of MBs in pediatric practice; however, the absence of uniform diagnostic criteria and management protocols creates clinical uncertainty.

Aim

Aim: To systematize current data on the prevalence, pathophysiology, clinical significance, diagnosis, and treatment of myocardial bridges in children.

Methods

Methods. A literature review was conducted using PubMed and eLibrary databases for the period 1997–2025 with keywords: myocardial bridging, children, coronary arteries, myocardial ischemia, MSCT coronary angiography.

Results

Results. The prevalence of MBs varies from 0.5–16% with coronary angiography to 22.5–35% with MSCT. The most common localization is the left anterior descending artery and its diagonal branches. The pathophysiological basis of ischemia is dynamic systolic compression, exacerbated by tachycardia. Clinical manifestations range from asymptomatic progression to life-threatening arrhythmias and sudden death. The diagnostic algorithm includes anatomical imaging (MSCT-CAG) and functional assessment (stress tests, intravascular ultrasound (IVUS)). First-line therapy consists of β-blockers; surgical myotomy is indicated in refractory cases.

Conclusion

Conclusion. MBs in children require a differentiated approach that includes anatomical imaging followed by functional assessment. Risk stratification strategies and evidence-based clinical guidelines derived from prospective studies in the pediatric population are needed.

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