Comparison of macroscopic, postmortem, angiographic and two-dimensional echocardiographic findings of coronary aneurysms in children with Kawasaki disease

To assess why the results of 2-dimensional echocardiography (2-D echo) for diagnosis of coronary aneurysm in patients with Kawasaki disease differed from those of cineangiography, the macroscopic, postmortem, angiographic and 2-D echocardiographic findings of 8 autopsied hearts of infants and children with Kawasaki disease were compared. Postmortem angiography and 2-D echo yielded similar results in aneurysms in which there was no thrombus, organization or marked thickening of the arterial wall. However, in aneurysms with complete or incomplete occlusion of the dilated cavity due to thrombi, organization or marked thickening of arterial wall, angiographic results reflected only the free cavity of the coronary aneurysm, but could not detect the original aneurysm. Two-dimensional echocardiography disclosed an echo-free space representing the original aneurysm, in which some materials, suggesting thrombi or organization, were found. However, it did not reveal whether the aneurysm was occlusive. This finding indicates that the discrepancies between the results of cineangiography and 2-D echo are attributable to the formation of large thrombi, organization or marked thickening of the arterial wall in the aneurysmal cavity. It is clinically important to know these limitations of angiography and 2-D echo.     

心电图正常的冠心病心绞痛患者冠状动脉造影特点

目的:为了解静息心电图正常的冠心病心绞痛患者冠状动脉(冠脉)造影特点,以提高诊断水平。方法:对268例静息心电图正常的冠心病心绞痛患者的冠脉造影结果进行分析。结果:冠脉造影显示2～3支血管病变201例,占75.0％,单支血管病变58例,占21.6％。201例2～3支血管病变中173例(86.1％)血管狭窄部位相互对应。2支血管病变为前降支和右冠者多见,占47.0％(63/134),单支血管病变以前降支者多见,占46.6％(27/58)。82.8％(48/58)单支血管狭窄为50％～74％。单纯左主干病变2例。结论:冠心病心绞痛患者冠脉2～3支血管病变者心电图正常与血管狭窄部位相互对应有关,单支血管病变与狭窄程度较轻有关。对临床上心电图正常疑为冠心病的患者,应及早做冠脉造影检查以明确诊断。     

Coronary artery disease in renal transplant recipients: an angiographic study

BackgroundCardiovascular disease is the leading cause of mortality in renal transplant recipients (RT). Coronary artery disease (CAD) in such patients is poorly studied.MethodsDuring 2012–2017, 50 patients with a renal graft (functioning for a minimum of 6 months) were subjected to coronary angiography in our institution. They were matched (for age, gender, diabetes, and indication for angiography) with 50 patients with end-stage renal disease (ESRD) undergoing chronic dialysis and 50 patients with normal renal function who were subjected to coronary angiography during the same period. The extent and severity of CAD were assessed by using the SYNTAX score.ResultsRT had a significantly longer duration of ESRD than patients on dialysis (17.5±7.1 vs. 8.5±8.7 years, p<0.01). Mean SYNTAX score was 13.3±12.0 in RT, 20.6±17.5 in patients on dialysis, and 9.4±9.2 in control patients (p<0.01). At least one significantly calcified lesion was present in 75.7% of RT recipients, 92.1% of patients on dialysis, and 15.8% of control patients (p<0.01). Percutaneous coronary intervention (PCI) was successful in 93.8% of the attempted cases in RT, 75% of patients on chronic dialysis, and 100% of control patients (p=0.04). In the RT group, SYNTAX score significantly correlated with smoking (p=0.02) and the total vintage of ESRD (p=0.04).ConclusionsIn this angiographic study, CAD was less severe in RT than in patients on long-term dialysis despite a longer duration of ESRD. Coronary artery calcification was highly prevalent after renal transplantation. PCI in RT had a high rate of angiographic success.     

Coronary artery aneurysms and myocardial infarction: adult sequelae of Kawasaki disease?

Coronary artery aneurysms developed in a 43 year old man who had suffered an acute myocardial infarction at the age of 30. In childhood he had had an illness that was consistent with Kawasaki disease, and it is suggested that the proximal discrete aneurysms and myocardial infarction may be the adult sequelae of this.     

Coronary artery aneurysms and myocardial infarction: adult sequelae of Kawasaki disease?

Coronary artery aneurysms developed in a 43 year old man who had suffered an acute myocardial infarction at the age of 30. In childhood he had had an illness that was consistent with Kawasaki disease, and it is suggested that the proximal discrete aneurysms and myocardial infarction may be the adult sequelae of this.     

Valvular regurgitation in patients with Kawasaki disease and in healthy children: a pulsed Doppler echocardiographic study

Valvular lesions in the acute stage of Kawasaki disease were observed using pulsed Doppler echocardiography. The subjects consisted of 65 patients with Kawasaki disease (2 months-6 2/12 years) who had been followed from the acute stage. The age-matched 113 controls were selected from 661 healthy children (2 months-14 years of age). In the acute stage of Kawasaki disease, tricuspid regurgitation (TR) was detected in 31 (48%), pulmonary regurgitation (PR) in 22 (34%) and mitral regurgitation (MR) in 17 (26%). There was no aortic regurgitation (AR). In the convalescent stage, TR was found in 26 (40%), PR in 20 (31%), and MR in 11 (17%), but no AR was detected. The incidence of each valvular regurgitation between the acute and convalescent stages in patients with Kawasaki disease did not differ significantly. Furthermore, there was no significant difference in the incidence of valvular regurgitation between patients with Kawasaki disease and the normal controls. In nine patients, however, valvular regurgitation in the acute stage had disappeared by the convalescent stage, and two patients had developed a new pansystolic murmur in the acute stage. We estimated the incidence of pathologic valvular involvement in Kawasaki disease to be 11/65 (17%). The incidence of valvular involvement in patients with coronary artery aneurysms was significantly higher than that of patients without coronary artery aneurysms (p less than 0.01). It was concluded that mild and transient valvular regurgitation, which cannot be detected by auscultation, may occur in some patients in the acute stage of Kawasaki disease. These may be caused by acute inflammation of the valve related to coronary artery lesions. In view of the Doppler echocardiographic findings in normal controls, these regurgitations should be distinguished from "physiological" ones.     

Subcostal 2-dimensional echocardiographic imaging of peripheral left coronary artery aneurysms in Kawasaki disease

Our previous study provided a new 2-dimensional echocardiographic technique to detect peripheral right coronary artery aneurysms in Kawasaki disease, with use of the subcostal approach. An additional study was performed to detect peripheral left coronary artery aneurysms. Because the left anterior descending artery runs along the anterior interventricular sulcus and the left circumflex artery along the mitral valve ring, these regions were searched for coronary aneurysms by use of the subcostal imaging approach. Among 143 patients with Kawasaki disease, 44 left coronary aneurysms were visualized in 22 patients. Three aneurysms at the origin of the obtuse marginal artery and 1 in the further peripheral site of the left circumflex artery were observed in 3 patients. Two aneurysms at the origin of the second diagonal branch of the peripheral left anterior descending artery were detected. These echocardiographic studies were done prospectively, and their features coincided well in size, shape, and anatomic location with confirmatory angiographic appearances.     

Coronary artery aneurysms and Kawasaki's disease in an adult

A 28 year old man had an acute myocardial infarction and was found to have coronary artery aneurysms. These may have been caused by a previous episode of Kawasaki's disease, an entity that should be considered in adults presenting with proximal discrete coronary artery aneurysms.     

Coronary artery aneurysms and Kawasaki's disease in an adult.

A 28 year old man had an acute myocardial infarction and was found to have coronary artery aneurysms. These may have been caused by a previous episode of Kawasaki's disease, an entity that should be considered in adults presenting with proximal discrete coronary artery aneurysms.