冠状动脉造影和三磷酸腺苷负荷超声心动图对川崎病冠状动脉损害远期追踪的价值

目的 探讨选择性冠状动脉造影及三磷酸腺苷负荷超声心动图对川崎病（KD）冠状动脉损害远期追踪的价值。方法 选取1999至2007年广州市儿童医院KD急性期超声心动图检查发现合并冠状动脉损害的患儿，同时采用三磷酸腺苷负荷超声心动图及选择性冠状动脉造影于恢复期进行远期随访。结果依据纳入标准和排除标准逐层筛选，确定9例KD患儿为本研究的样本。男8例，女1例，急性期发病年龄为1～10岁，平均（4.44±3.09）岁。检查时年龄4～12岁，平均（7.89±2.62）岁。追踪时间1.5~7年，平均（3.44±1.67）年。急性期超声心动图示9例患儿中冠状动脉巨瘤5例，冠状动脉瘤3例，冠状动脉扩张1例。三磷酸腺苷负荷超声心动图示：节段性室壁运动异常6/9例；冠状动脉血流储备下降5/9例。冠状动脉造影示：双侧主干冠状动脉瘤4例，同时伴远端动脉瘤3处，冠状动脉左前降支狭窄1处，并冠状动脉扭曲，狭窄或充盈缺损3处，附近侧支血管形成1处；左前降支动脉瘤、右冠状动脉闭塞伴侧支循环形成1例，冠状动脉扩张4例。与同期超声心动图检查比较 ，冠状动脉造影新发现冠状动脉远端瘤3处，右冠状动脉远端狭窄2处，左前降支狭窄1处，右冠状动脉闭塞伴侧支血管形成1例。5例三磷酸腺苷负荷超声心动图检查结果阳性者与冠状动脉造影比较：均发现相应冠状动脉支狭窄或充盈缺损表现；1例三磷酸腺苷负荷超声心动图检查结果阳性，冠状动脉造影仅见轻度冠状动脉扩张。结论 KD合并冠状动脉损害特别是动脉瘤造成的心脏损害可长期存在。对于远期追踪观察KD患儿冠状动脉病变，三磷酸腺苷负荷超声心动图具无创、安全可靠的优点，是判断心肌缺血的重要方法；选择性冠状动脉造影可明确显示冠状动脉病变的位置、形态、数目及严重程度，特别对冠状动脉狭窄、闭塞及远端病变能做出准确的评估。两种方法结合检查对KD冠状动脉损害的远期追踪有重要帮助。

The value of ATP stress echocardiography and selective coronary angiography for long-term following-up in children with coronary artery lesions by Kawasaki disease

Objective To explore the value of ATP stress echocardiography and selective coronary angiography(SCAG) for long term follow up in children with coronary artery lesions by Kawasaki disease.Methods The ATP stress echocardiography and SCAG were perfomed on 9 children (1 female and 8 males) with a history of Kawasaki disease(5 with giant coronary aneurysms,3 with coronary aneurysms ,and 1 with dilatation of bilateral coronary arteries in acute stage). The average age of the patients was (7.89±2.62) years(4-12 years) when SCAG was taken，the follow up period was 1.5-7years［average（ 3.44±1.67）years］from onset.Results The wall motion abnormality in 6 cases, decreased coronary flow reserve in 5 cases were found by ATP stress echocardiography. SCAG showed : the multiple bilateral coronary aneurysms in 4 cases(1 of them with LAD stenosis; 2 of 4 with right coronary artery tortuous and stenosis); left anterior descending coronary aneurysms with right coronary artery occlusion and collateral branches in 1 case;dilatation of coronary arteries in 4 cases . Comparing with SCAG, 3 distal coronary aneurysms in 2 cases ; coronary stenosis in 3 cases, coronary collateral branches in 2 cases were found by ATP stress echocardiography. Comparing with ATP stress echocardiography, 5 of 6 cases with wall motion abnormalities were found to have coronary tortuous and stenosis in relative diferent arteries by SCAG. Conclusions The coronary artery lesions caused by Kawasaki disease may last for long time，it is nesscery to have long term follow up for patients with kawasaki disease.The ATP stress echocardiography is safe and reliable for detecting the myocardial ischemia; The selective coronary angiography can show the coronary artery lesions in number, diferent form and site, especially in finding coronary stenosis,distal aneurysms and coronary collateral branches. It is very helpful to evaluate the coronary artery lesions caused by Kawasaki disease for long term follow-up.