• Journal of Chest Surgery
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• 제30권1호
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• pp.27-33
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• 1997

관상동맥 우회술에 있어서 전방성 심정지액 주입에 의한 심근 보호의 한계성으로 심정지액의 적절한 분포를 위한 역행성 심정지액의 사용이 점차 일반화되고 있다. 본 서울대학교병원에서는 1994년 4월부터 1995년 8월까지 관상동맥 우회술을 시행한 95례중 76례에서 역행성 심정 지액을 이용한 관상동맥 우회술을 시행하였다. 남녀 성비는 남자가 48명, 여자가 28명이며, 평균 연령은 58.2$\pm$8.3세였다. 술전 진단으로 불안정성 협심증이 53례(70%), 안정성 협심증이 14례(18%), 심근 경색후 협심증이 6례 (8%), 경퍼적 관상동맥 확장술후 합병증이 2례 (3%), 급성 심근경색증이 1례 (1%)이었다. 술전 관상동맥 조명술상 3중혈관 질환이 42례 (55%), 2중혈관 질환이 11례 (14%), 단일혈관 질환이 10례 (13%), 좌주관상동맥 질환이 13례(17%) 로, 수술시 대복재정맥 이외에 좌측 내유동맥을 이용한 경우가 69례, 우측 내유동맥의 경우 11례, 좌측 요골동맥을 사용한 경우가 6례, 우측 위대망막동맥의 경우가 1례이었다. 환자 1인당 문합은 평균 3.2 $\pm$ 1.1개이었다 심정지액 주입 방법으로는 75례에서 전향성 심정지액 주입으로 심정지를 유도한 후 역행성 심정지액 주입으로 심근보호를 유지하였고, 역행성 심정지액 주입만으로 심정지유도 및 심근보호를 유지한 경우도 1례가 있었다. 역행성 심정 지액을 간헐적으로 주입한 경우가 19례, 계속적으로 주입한 경우가 57례이었으며, 우관상동맥 문합을 시행하였던 39례의 환자에서는 역행성 심정지액 주입법 및 우관상동맥 이식 편을 통한 전향성 심정지액의 동시주입법을 실시하였다. 수술 사망은 없었으며, 수술후 합병증으로는 부정맥이 15례 (20%), 수술후 심근경 색증이 10례 (13%), 저심박출증이 8례(11%),술후 일과성 신경학적 합병증이 7례 (9%),술후 일과성 정신과적 합병증이 6례 (8%), 급성 신부전이 3례 (4%),술후 출혈 및 폐렴이 각각 2례 (3%), 창상 감염과 십이지장 궤양 천공이 각각 1례 (1 %)이었다. 역행성심정 지액을 이용한 심근 보호법은 고위험도의 허혈성 심질환 환자에서의 관상동맥 우회술에서 수술 위험도를 최소화할 수 있는 유용한 심근 보호법이라고 생각된다.

• Journal of Chest Surgery
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• 제37권11호
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• pp.897-902
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• 2004

배경: 관상동맥조영술 또는 중재술에 사용된 요골동맥을 관상동맥우회술시 우회도관으로 사용하는 경우가 늘고 있으나 이로 인한 요골동맥도관의 개존성 및 환자의 임상성적에 미치는 영향에 대해 체계적인 연구는 보고되고 있지 않다. 이에 본 저자들은 관상동맥조영술에 사용된 요골동맥을 우회도 관으로 사용한 환자들의 임상성적과 술 후 개존도를 그렇지 않은 환자들과 비교 분석하고자 하였다. 대상 및 방법: 2000년 1월 부터 2004년 2월까지 관상동맥조영술에 사용된 요골동맥을 동맥도관으로 사용한 49예를 I군으로, 관상동맥조영술에 산이지 않은 요골동맥을 동맥도관으로 사용한 44예를 II군으로 정하여 두 군간에 성비, 나이, 술 전 위험인자, 과거력, 임상진단, 수술방법, 수술성적, 우회도관의 개존도 등을 후향적으로 비교 분석하였다. 결과: 두 군 간 남녀비, 연령, 진단명, 수술 위험인자, 심박출률 등의 유의한 차이는 없었다. 술 전 관상동맥조영술은 I군에서는 전예에서 좌측 요골동맥을 이용하였고 II군에서는 대퇴동맥 혹은 우측 요골동맥을 이용하였다. 수술은 전예에서 인공심폐기를 이용한 관상동맥우회술을 시행하였으며 수술사망은 양군에서 모두 없었고 주요합병증은 I군은 5예(10%), II군은 3예(7%) 있었다. 수술에 이용된 우회도관으로는 양군에서 내흉동맥, 요골동맥, 대복재 정맥을 주로 이용하였고 I군은 환자당 평균 3.7$\pm$1.1원위부문합, II군은 3.7$\pm$0.9원위부문합을 시행하였고 요골동맥절편은 I군에서 환자당 평균 1.2$\pm$0.4원위부문합, II군에서 1.3$\pm$0.5원위부문합을 시행하였다. 요골동맥의 원위부문합은 양 군에서 회선지 부위가 가장 많았고 근위부문합은 두군에서 모두 상행대동맥, 내흉동맥, 대복재정맥 후드 순이었다. 수술 후 관상동맥조영술상 양군에서 내흉동맥과 요골동맥은 모두 100%의 개존도를 보였으며 대복재정맥은 I군 85%, II군 86%의 개존도를 보였다. 요골동맥절편에서 완전개존이 I군에서 93%로 II군의 81%보다 오히려 높게 나왔으나 유의하지는 않았다. 결론: 술 후 시행한 관상동맥조영술에서 양군에 개존율에 큰 차이는 없었으며 수술 전 관상동맥 조영술에 사용된 요골동맥도 비교적 안전하게 관상동맥우회술의 우회도관으로 사용할 수 있다고 판단된다.

• 대한한방내과학회지
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• 제30권2호
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• pp.422-430
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• 2009

Background : Stroke is the second leading cause of death in Korea, following cancer. Stroke consists of ischemic and hemorrhagic stroke, and ischemic stroke can be largely classified as atherothrombotic stroke or embolic stroke. Carotid intima-media thickness (IMT) is an indicator of atherosclerosis used commonly as a screening test for abnormalities of the coronary artery. 24-hour ambulatory ECG is widely used to screen for underlying diseases that causes syncope, palpitation, arrhythmia, etc. Objectives : Since both carotid IMT and 24-hour ambulatory ECG are used to screen for cardiac problems, we endeavored to explore the correlation between carotid IMT and 24-hour ambulatory ECG of stroke patients. Methods : The records of ischemic stroke patients who were admitted to Kyunghee Medical Center Oriental Hospital ward from March 2006 to May 2009 were reviewed. 28 patients who had both carotid Doppler US and 24-hour ambulatory ECG test undertaken during their admission were analyzed. The relationship of abnormal ambulatory results and common carotid artery(CCA) IMT were statistically analyzed using Fisher's exact test and t-test. Results : The mean age of the abnormal ambulatory group was older than the normal group (74${\pm}$ 8.0 vs. 61${\pm}$12.1, p=0.0098). Although insignificant, the abnormal ambulatory group showed much thicker CCA-IMT than normal ambulatory group (2.l7${\pm}$ 1.16 vs. 1.51${\pm}$0.97. p=0.l389). Conclusion: No significant correlation was observed between abnormal ambulatory results and CCA-IMT. However, the difference in CCA-IMT between the two groups was too big to be ignored and further investigation with larger and better controlled trials are warranted.

• Journal of Chest Surgery
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• 제29권3호
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• pp.278-284
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• 1996

1989년 5월부터 1994년 5월까지 9명의 대혈관전위증 환자에 대해 동맥전환술을 시행하였다. 연령 분 포는 생후 3일에서 90일까지로 평균 30일 (21일)이 었고 환자는 전례 에서 술전 심초음파 검사로 진단되 었 다. 8례는 심실중격결손을 동반한 대혈관전위증이었으며 1례는 심실중격결손을 동반하지 않은 단순대 혈관잔위증 환아였다. 동반기형으로는 동맥관개존이 8례, 심방중격결손이 7El,대동맥축약이 1례였다. 관동백의 분지 형태는 Yacoub type A가 7례 (77 %), Yacoub type D의 형태가 2례 (23 %)였다. 폐동맥 재 건은 Lecompte 술식을 8례 에서 적용하였고 자가심낭편을 이용하였다. 사망율은 55 %였다. 수술후 1 ~2 일내 사망한 3례는 좌심실 기능부전과 발작성 폐동맥 고혈압이 원인이었고, 수술후 2~3주에 사망한 2례는 술후 감염에 의한 폐혈증이 주원인이었다. 평균 추적 기간은 17개월이 었고 추적관찰에는 심초음파 를 이용하였으며 임상적으로 의미 있는 대동맥 판 폐쇄부전이나 폐동맥 판 상부 협착은 발견되지 않았다. 수술에 따르는 여러 위험 요소들(저체중, 장시간의 체외순환, 체외 순환중 과도한 혈희석, 저체온, 술후 용적 부하, 과도한 \ulcorner\ulcorner\ulcorner사용) 중 술후 과도한 강심제를 사용했을 경우에서만 통계학적 유의성을 가지는 위험인자로 나타났다.

• Journal of Radiation Protection and Research
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• 제25권4호
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• pp.191-195
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• 2000

현재 서울대학교병원에서 진행중인 연구의 일환으로 혈관 내 방사선치료 시 시술자의 방사선피폭 정도 및 위험성에 대해 알아보고자 연구를 시행하였다. 심장혈관 폐색으로 연구에 포함되어 방사선치료른 시행 받은 42명의 환자 중 측정이 완벽한 34명의 자료를 토대로 분석을 시행하였다. 혈관내 방사선치료는 관상동맥성형술 직후 풍선도자법을 이용하여 대상 동맥의 중막에 17 Gy를 조사하였다. 사용된 동위원소는 $^{188}Re$이었으며 GM측정기로 각기 다른 8점에서 피폭선량을 측정하였다. 환자의 심장부위에서 10cm, 40cm 떨어진 지점을 시술자의 최대피폭량, 전신피폭량의 기준으로 삼았다. 치료선량의 중앙값은 111.6 mCi이었고 중앙치료시간은 576초였다. 환자 심장부위에서 l0cm, 40cm 지점의 평균 피폭 선량율은 0.43 mSv/hr, 0.30 mSv/hr 이었고, 각 지점에서의 시술 당 평균 피폭 선량은 0.07 mSv, 0.05 mSv 이었다. 이 수치는 ICRP-60나 과학기술부 고시에서 권고하고 있는 한계 피폭선량보다 훨씬 적은 값으로 현재 저울대학교병원에서 시행하고 있는 혈관내 방사선 치료법은 방사선방어 면에서 매우 안전한 방법임을 확인할 수 있었다.

• Journal of Chest Surgery
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• 제12권3호
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• pp.281-288
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• 제12권3호
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• pp.289-296
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• 대한한방내과학회지
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• 제18권2호
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• pp.220-228
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• 1997

Background The stenosis of the coronary artery may decrease myocardial oxygen supply and occur myocardial ischemia or infarction. Soojeomsan, one of analgesics is generally regarded to have the effect of vitalizing blood, expelling blood stasis and alleviation cardiac pain. Methods The purpose of this experimental study is to find the influence of Soojeomsan on cardiac enzyme (CPK, Na-K ATPase) of ischemic and reperfused rat hearts which are isolated under the Langendorff apparatus. Ischemia was induced In isolated hearts of Sprague-Dawley rats by ceasing the perfusion for 20 minutes. The experiments were divided into a normal saline orally administered group(control group), a Soojeomsan orally 20ml administered group(sample A) and a Soojeomsan orally 30ml administered group(sample B). The CPK (creatinine phosphokinase) and Na-K ATPase activity of this three group were measured and compared in order to assess the influence of Soojeomsan on protection of isolated rat hearts from ischemia. Results 1. CPK was significantly reduced in Sample A group and Sample B group in comparison with control group in reperfusion(P<0.01), and there were no significant difference between Sample A and B. 2. Na-K ATPase activity was significantly increased in Sample A group and Sample B group in comparison with control group in ischemia(P<0.001), and the activity was significantly higher in Sample B then in Sample A.(P<0.01) 3. There were no significant difference in Na-K ATPase activity of the three groups after reperfusion. Conclusion Soojeomsan has effects to decrease CPK activity and activate Na pump. This result in protection of the myocardium of isolated rat hearts from ischemia.

• 한국방사선학회논문지
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• 제13권5호
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• pp.713-720
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• 2019

본 연구의 목적은 컴퓨터단층 혈관조영술에서 혈관 직경을 정확하게 측정할 수 있는 새로운 측정 방법인 상대적 측정법의 기초연구 자료를 제공하고자 한다. 비이온성 요오드 조영제를 자체 제작한 관류 팬텀에 일정한 속도로 흐르게 한 후 컴퓨터단층 혈관조영술 검사를 시행하였다. 원시 데이터를 얻은 후 다중평면재구성 및 최대강도투사법으로 영상을 재구성하였고 장비 사에서 제공하는 거리측정 장치를 사용하여 팬텀의 직경을 측정하였다. 측정법은 고식적 측정법과 본 연구에서 제안하는 상대적 측정법을 사용하였다. 관류팬텀의 평균 직경은 다중평면재구성기법과 최대강도투사법 모두에서 상대적 측정법이 기존 측정법 보다 실측에 더 가깝게 나타났다(34% VS 24%, p<0.05). 하지만 두 가지 측정법 모두 실측보다 여전히 확대된 결과를 나타내고 있음을 확인하였다. 따라서 상대적 측정 방법에 대한 추가 연구가 필요한 실정이며, 이에 본 연구가 기초 자료를 제공할 수 있을 것이라 사료된다.

• Korean Journal of Radiology
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• 제22권12호
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• pp.1964-1973
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• 2021

Objective: To investigate the diagnostic performance of CT fractional flow reserve (CT-FFR) for myocardial bridging-related ischemia using dynamic CT myocardial perfusion imaging (CT-MPI) as a reference standard. Materials and Methods: Dynamic CT-MPI and coronary CT angiography (CCTA) data obtained from 498 symptomatic patients were retrospectively reviewed. Seventy-five patients (mean age ± standard deviation, 62.7 ± 13.2 years; 48 males) who showed myocardial bridging in the left anterior descending artery without concomitant obstructive stenosis on the imaging were included. The change in CT-FFR across myocardial bridging (ΔCT-FFR, defined as the difference in CT-FFR values between the proximal and distal ends of the myocardial bridging) in different cardiac phases, as well as other anatomical parameters, were measured to evaluate their performance for diagnosing myocardial bridging-related myocardial ischemia using dynamic CT-MPI as the reference standard (myocardial blood flow < 100 mL/100 mL/min or myocardial blood flow ratio ≤ 0.8). Results: ΔCT-FFR_systolic (ΔCT-FFR calculated in the best systolic phase) was higher in patients with vs. without myocardial bridging-related myocardial ischemia (median [interquartile range], 0.12 [0.08-0.17] vs. 0.04 [0.01-0.07], p < 0.001), while CT-FFR_systolic (CT-FFR distal to the myocardial bridging calculated in the best systolic phase) was lower (0.85 [0.81-0.89] vs. 0.91 [0.88-0.96], p = 0.043). In contrast, ΔCT-FFR_diastolic (ΔCT-FFR calculated in the best diastolic phase) and CT-FFR_diastolic (CT-FFR distal to the myocardial bridging calculated in the best diastolic phase) did not differ significantly. Receiver operating characteristic curve analysis showed that ΔCT-FFR_systolic had largest area under the curve (0.822; 95% confidence interval, 0.717-0.901) for identifying myocardial bridging-related ischemia. ΔCT-FFR_systolic had the highest sensitivity (91.7%) and negative predictive value (NPV) (97.8%). ΔCT-FFR_diastolic had the highest specificity (85.7%) for diagnosing myocardial bridging-related ischemia. The positive predictive values of all CT-related parameters were low. Conclusion: ΔCT-FFR_systolic reliably excluded myocardial bridging-related ischemia with high sensitivity and NPV. Myocardial bridging showing positive CT-FFR results requires further evaluation.