Table 1.
Detailed findings of children with KD and left circumflex coronary artery involvement.
| Patient No. | Age at diagnosis/Sex | Interval between diagnosis and CTCA (in years) | Transthoracic echocardiography (TTE) findings | CT coronary angiography |
|
|---|---|---|---|---|---|
| Findings in left circumflex coronary artery | Findings in other coronary arteries (LCA, LAD, RCA) | ||||
| 1. | 4 Y/M | CTCA carried out on follow-up at 4 years | Baseline: LCA: 2.8 (+1.57Z) LAD: 1.8 (+0.30) RCA: 1.8 (−0.33) LCx: NV Follow-upa: Normal |
9.8 mm long segment stenosis with 30–40% luminal diameter reduction. Distal LCx normal | Normal |
| 2. | 9 Y/F (Fig. 1) | CTCA carried out on follow-up at 2.5 years | Baseline: LCA mild dilation, other coronaries normal Follow-upa: Normal |
Multiple saccular aneurysms in distal most OM1 branch give a bunch of grapes appearance. | Normal |
| 3. | 7 months/M (Fig. 2) | CTCA carried out at presentation | LCA: 3.2 mm (+3.7Z) LAD: 12 mm (thrombosis) RCA: 3.5 mm (+7Z) LCx: NV |
LCx 7.2 mm fusiform giant aneurysm starting at proximal segments extending to the distal segment | LAD 18 mm (proximal and mid-segment) giant fusiform aneurysm along with thrombosis measuring 9 mm. RCA 4.5 mm fusiform aneurysm. LCA fusiform aneurysm 3 mm. |
| 4. | 4Y/M | CTCA carried out on follow-up at 5 years | Baseline: LCA: 3.2 mm fusiform aneurysm (Z score NA) LAD: 4.4 mm fusiform aneurysm (Z score NA) RCA: 2.2 mm LCx: NV Follow-upa: LCA 4.2 mm dilated and LAD: 2.5 mm dilated, LCx: NV |
Proximal segment fusiform aneurysm for 2.6–2.8 cm segment | Fusiform aneurysm in LCA and LAD |
| 5. | 12 Y/M (Fig. 4a) | CTCA carried out at presentation | LAD: 6.8 mm (+9.79Z) RCA: 6.4 mm (+8.09Z) LCx: NV |
Fusiform aneurysm of proximal LCx with extension to OM1 branch | Fusiform aneurysm of entire LAD and RCA |
| 6. | 8 months/M (Fig. 7a and b) | CTCA carried out at presentation | LCA: 6.0 mm (+12.5Z) LAD: 6.8 mm (+17.06Z) RCA: 7 mm (+17.0Z) LCx: NV |
Saccular aneurysm at origin with non-opacified LCx in further course suggestive of thrombosis (8 mm) | Distal LCA saccular aneurysm (8 mm), proximal LAD saccualr aneurysm (7 mm), proximal RCA fusiform (6.4 mm) and distal RCA saccualr aneurysm (2.7 mm) |
| 7. | 7.5 months/M | CTCA carried out on follow-up at 10 years | Baseline: LCA: 3.2 mm fusiform aneurysm (Z score NA) RCA: 2.2 mm fusiform aneurysm (Z score NA) LAD: 1.5 mm dilated LCx: NV Follow-upa: normal |
LCx fusiform aneurysm (4.7 mm; length 1.4 cm) | Fusiform dilatation in LCA with extension into LCx. Saccular aneurysm in RCA |
| 8. | 7 months/M | CTCA carried out at presentation | LCA: 5 mm (+10.3Z) LAD: 4.7 mm (+11.3Z) RCA: 4.2 mm (+8.5Z) LCx: 1.7 mm (+1.7Z) |
Proximal and mid LCx fusiform giant aneurysm (3.2 mm) | LCA giant aneurysm (5.2 mm), proximal and mid LAD fusiform aneurysm (3.5 mm), proximal RCA fusiform aneurysm and fusiform aneurysm (3.5 × 5 mm) at bifurcation of RCA |
| 9. | 2 Y/M | CTCA carried out on follow-up at 8 years | LCA: 3.3 mm (+3.56Z) LAD: 10 mm (+24.81Z) RCA: 5.8 mm (+11.75Z) LCx normal |
LCx just beyond its origin fusiform aneurysm till bifurcation (3.4 mm and 13 mm length) | LCA dilated, LAD long segment (2.2 cm) dilatation, and RCA fusiform aneurysm (4.3 mm). Mid segment RCA thickly calcified aneurysm (5.3 mm). |
| 10. | 11 months/M (Fig. 4b) | CTCA carried out at presentation | LCA: 2.4 mm (+0.77Z) LAD: 1.7 mm (+0.16Z) RCA: 1.2 mm (−1.4Z) LCx 1.6 mm (+0.93Z) with loss of tapering |
Fusiform aneurysm of proximal (4.5 mm) and mid (4.2 mm) and its OM1 branch involvement (2.4 mm; length 6–7 mm) | Normal |
| 11. | 5 months/M | CTCA carried out at presentation | LCA: 2.3 mm (+2.62Z) LAD: 2.2 mm (+3.61Z) RCA: 1.3 mm (+0.19Z) LCx: NV |
Proximal LCx fusiform aneurysmal dilatation | Proximal and mid LAD dilatation and fusiform aneurysm in distal LAD |
| 12. | 1.5 Y/F (Fig. 6) | CTCA carried out at presentation | LCA: 5.9 mm (+12.0Z) LAD: 5.1 mm (+11.9 Z) RCA: 3.2 mm (+5.0Z) LCx: 3.4 mm (+6.5Z) |
Proximal LCx giant fusiform aneurysm (5.8 mm) | LCA, LAD and RCA (14 mm × 1.7 cm) giant aneurysms |
| 13. | 3 Y/M | CTCA carried out at presentation | LCA: 4.7 mm (+6.32Z) LAD: 5.3 mm (+12.79Z) RCA: 5.8 mm (+11.6Z) LCx: 2.3 mm (+3.3Z) |
Proximal LCx fusiform giant aneurysm (4 mm × 25 mm) | Proximal LAD fusiform aneurysm, proximal RCA giant aneurysm |
| 14. | 6 Y/F | CTCA carried out on follow-up at 9 years | Baseline: LCA: 6 mm (+8.79Z) LAD: 8 mm (+16.30Z) RCA: 4 mm (+4.39Z) LCx: NV Follow-upa: LCA: 3 mm (−1.11Z) LAD: 9.4 mm (+14.31Z) with calcification RCA: 3.9 mm (+1.28Z) LCx: NV |
Fusiform aneurysm in LCx in its proximal and mid segment (4 mm) | Distal LCA and proximal segment LAD shows densely calcified giant fusiform aneurysm (8.4 mm × 20 mm). RCA densely calcified fusiform aneurysm (5.5mm × 17.5 mm) in RCA in proximal segment and distal RCA (4.2 mm) aneurysm |
| 15. | 4 Y/M (Fig. 3) | CTCA carried out at presentation | LCA: 3 mm (+2.17Z) LAD: 3.85 mm (+6.13Z) RCA: NA LCx: NV |
Distal LCx fusiform aneurysm (3 mm) | LAD fusiform aneurysm (3.5 mm) |
| 16. | 10 months/M | CTCA carried out at presentation | LCA: 3.8 mm (+5.83 Z) LAD: 4.5 mm (+9.70) RCA: 3.2 mm (+4.71Z) LCx: 2.5 mm (+3.53) |
Proximal Lcx fusiform aneurysm | LAD saccular giant aneurysm (6.5 mm), RCA fusiform aneurysm |
| 17. | 9 months/M | CTCA carried out on follow-up at 5 years | Baseline: LCA: 4.8 mm (+8.9Z) LAD: NA RCA: 5 mm (+11.08Z) LCx: NV Follow-upa: LCA: 3.4 (+2.1Z) LAD: 3.1 mm (+2.9Z) RCA: 2.9 mm (+1.5Z) LCx: NV |
Proximal and mid LCx fusiform aneurysm | LCA, LAD and RCA fusiform aneurysms |
| 18. | 4 Y/M | CTCA carried out on follow-up at 1 year | Baseline: LCA: 7.0 mm (+12.78) LAD: 5 mm (+9.55) RCA: 2.2 mm (+0.83) LCx: NV Follow-upa: LCA: 6.7 mm (+11.98) LAD: 5 mm (+9.55) RCA: 2.7 mm (+2.10) LCx: NV |
LCx arising from aneurysmal segment followed marked narrowing | Distal LCA fusiform aneurysm, LAD fusiform aneurysm (4.5 mm) |
| 19. | 5 Y/M | CTCA carried out at presentation | LCA: 3.5 mm (+2.23 Z) LAD: 6.8 mm (+16.05Z) RCA: 5.7 mm (+10.14Z) LCx: 4.3 mm (+6.43Z) |
Proximal fusiform aneurysm (3.9 mm). Another fusiform aneurysm in the distal LCx segment (3.6 mm). Intervening mid-segment is normal. | LAD and RCA show fusiform aneurysm in proximal segments LAD (7.7 mm); RCA (6.0 MM) with multiple skip aneurysms giving a beaded appearance. |
| 20. | 8 months/M (Fig. 7c and d) | CTCA carried out at presentation | LAD: 9.2 mm (+16Z) RCA: 7 mm (+13Z) LCx: NV |
LCx nonopacified (suggestive of thrombosis) | Large fusiform aneurysm LAD (7.0 mm), RCA (5.0 mm) diffusely dilated in entire course. |
| 21. | 11 Y/M | CTCA carried out at presentation | LCA: 5.1 mm (+5.2Z) LAD: 5.6 mm (8.4Z) RCA: NA LCx: NV |
Proximal and mid LCx fusiform giant aneurysm (5.1 mm) | LCA dilated, multiple fusiform aneurysms throughout RCA and proximal RCA giant aneurysm |
| 22. | 3 Y/M | CTCA carried out at presentation | LCA: 3.2 mm (+2.95Z) LAD: 3.5 mm (+5.42 Z) RCA: 2.6 mm (+1.98Z) LCx: NV |
Proximal LCx fusiform aneurysm (3.6 mm) | Fusiform dilatation of LCA with extending into proximal LAD |
| 23. | 2 Y/M | CTCA carried out at presentation | LCA: (3 mm; +2.74Z) LAD: (8 mm; +18.96Z) LCx: NV |
Proximal LCx fusiform aneurysm (3.5 mm) | LCA dilated (3.5 mm), distal LAD giant fusiform aneurysm (6.7 mm), and RCA dilatation |
| 24. | 5 months/M | CTCA carried out on follow-up at 2 years | Baseline: LCA: 4 mm (+7.11Z) LAD: 6.6 mm (+17.11Z) RCA: 4.6 mm (+10.54Z) LCx: NV Follow-upa: LCA: 3.6 mm (+1.38Z) LAD: 3.0 mm (+1.68Z) RCA: 2.1 mm (−1.19Z) LCx: 2 mm (−0.54Z) |
Proximal LCx fusiform aneurysm | LCA (3.6 mm), proximal and mid LAD (3.1 mm) fusiform aneurysm along with discontinuous fusiform aneurysm in distal LAD. Normal RCA. |
| 25. | 3 Y/F | CTCA carried out at presentation | LCA: 3.56 mm (+3.85Z) LAD: 2.5 mm (+2.5Z) RCA: 4.02 mm (+6.43Z) LCx: NV |
Proximal LCx fusiform aneurysm (2.7 mm) | Proximal and mid LAD aneurysm (3.2 mm × 15 mm), RCA (4.4 mm) |
| 26. | 1.5 Y/M (Fig. 5) | CTCA carried out on follow-up at 6 years | Baseline: LCA: 3 mm (+3.49Z) LAD: 1.4 mm (+0.09) RCA: 2.2 mm (+1.85Z) LCx: NV Follow-upa: Normal |
OM1 branch of LCx shows stenosis causing 30–50% luminal narrowing | Normal |
| 27. | 6 Y/M | CTCA carried out at presentation | LCA: 3.1 mm (+4.6Z) LAD: 6.4 mm (+16.8Z) RCA: 9.4 mm (+24Z) LCX: 3.2 mm (+6.4Z) |
Proximal LCx fusiform giant aneurysm (4.1 mm × 10.7 mm) | LCA dilated (3.8 mm), LAD fusiform aneurysm (6.6 mm × 16.3 mm), RCA fusiform aneurysm (prox-8 mm, mid-5.2 mm, distal −4.2 mm) |
| 28. | 3 Y/M | CTCA carried out at presentation | LCA: 5.2 mm (+7.6Z) LAD: 3.2 mm (+4.1Z) RCA: 3.7 mm (+4.3Z) LCx: 2.8 mm (+2.9Z) |
Fusiform aneurysm in (2.4 mm) in entire course of LCx | LCA fusiform aneurysm, LAD fusiform aneurysm (3.5 mm) and RCA fusiform aneurysm (2.4 mm) |
| 29. | 9 Y/M | CTCA carried out at presentation | LCA: 4.5 mm (+3.87Z) LAD: 4.3 mm (+5.78Z) RCA: 4.6 mm (+5.11Z) LCx: 3 mm (+2.06Z) |
Fusiform aneurysm in (3.3 mm) in entire course of LCx | LCA dilated, LAD dilated (4.2 mm) and RCA diffusely dilated in entire course (5.6 mm) |
| 30. | 1.9 Y/M | CTCA carried out at presentation | LCA: 3.7 mm (+4.92Z) LAD: 6.5 mm (+14.96Z) RCA: 4.3 mm (+7.11Z) LCx: 4.3 mm (+8.01Z) |
Proximal LCx fusiform giant aneurysm (6.0 mm) | LCA and LAD fusiform giant aneurysm (8 mm) and RCA fusiform dilatation (4.6 mm) |
| 31. | 10 Y/M | CTCA carried out at presentation | LCA: 4.5 mm (+2.49Z) LAD: 4.1 mm (+3.49Z) RCA: 3.8 mm (+1.6Z) LCX: 3.9 mm (+2.6Z) |
Proximal and mid segment fusiform dilation (2.7 mm) | LCA and LAD diffuse dilated in entire course (2.7 mm), RCA dilated proximal and mid segment (1.8 mm) |
| 32. | 1 Y/F | CTCA carried out at presentation | LCA: 4.9 mm (+9.9Z) LAD: 2.5 mm (+4Z) RCA: 1.4 mm (+2.7Z) LCX: 2.0 mm (+2.7Z) |
Proximal LCx fusiform aneurysm (2.0 mm) | LCA saccular aneurysm (6.4 mm), LAD fusiform aneurysm proximal segment (3.6 mm) |
| 33. | 2 months/F | CTCA carried out at presentation | LCA: 2.9 mm (+5.31Z) LAD: 3.3 mm (+8.27Z) RCA: 2.9 mm (+6.1Z) LCx: 1.9 mm (+3.74Z) |
Proximal LCx fusiform aneurysm (2.4 mm) | LCA dilated (2.5 mm), LAD fusiform aneurysm (3.8 mm) and RCA fusiform aneurysm (2.7 mm) |
| 34. | 6 Y/M | CTCA carried out at presentation | LCA: 3 mm (+1.3Z) LAD: 6.6 mm (+12.1Z) RCA: 6.3 mm (+9.43Z) LCX: 5.4 mm (+8.1Z) |
Proximal LCx fusiform large aneurysm (4.1 mm) | LAD fusiform aneurysm (6.4 mm) and RCA discontinuous fusiform aneurysms RCA (5.1 mm, 6.3 mm. 3.4 mm). |
| 35. | 7 months/M | CTCA carried out at presentation | LCA: 3.29 mm (+4.28Z) LAD: 3.22 mm (+6.59Z) RCA: 4.9 mm (+11.58Z) LCx: 1.8 mm (+2.13Z) |
Two discontinuous fusiform aneurysms in mid LCX (2.5 mm, 3.3 mm) | LAD fusiform aneurysm (4.2 mm), RCA fusiform aneurysms (4.9 mm, 5.8 mm) |
| 36. | 3.5 Y/M | CTCA carried out on follow-up at 4.5 years | Baseline: LCA: 6.5 mm (+11.3Z) LAD: 2.2 mm (+1.5Z) RCA: 4 mm (+5.3Z) LCx: NV Follow-upa: LCA: 6.17 mm (+6.71Z) LAD: 10.3 mm (+18.6Z) RCA: 2.98 mm (+0.46Z) LCx: NV |
Proximal LCx giant fusiform aneurysm (8.4 mm) | Fusiform aneurysm in distal LCA extending in LCx. LAD thrombotic occlusion beyond its origin, thickly calcified thrombosed saccular aneurysm LAD (12.6 mm). RCA dilated in proximal segment (2.8 mm) with fusiform aneurysms in mid and distal RCA (3.5 mm and 3.2 mm) |
| 37. | 6 Y/M | CTCA carried out at presentation | LCA: 4 mm (+3.96Z) LAD: 4.2 mm (+6Z) RCA: 5.6 mm (+7.98Z) LCx: 2 mm (+0.31Z) |
Fusiform aneurysm in (3.5 mm) in entire course of LCx | Fusiform aneurysms in LCA (5.9 mm), LAD (3.9 mm) and RCA (7.3 mm) |
| 38. | 9 Y/M | CTCA carried out at presentation | LCA: 6.8 mm (+9.46Z) LAD: 5 mm (+8.9Z) RCA: 3.2 mm (+2.7Z) LCx: 4.87 mm (+6.52Z) |
Fusiform aneurysm in (3.7 mm) in entire course of LCx | Fusiform aneurysms in LCA (4.5 mm), LAD (4.4 mm) and RCA (2.5 mm) |
| 39. | 5 Y/M | CTCA carried out at presentation | LCA: 3.7 mm (+3.25Z) LAD: 4.1 mm (+6.08Z) RCA: 4.6 mm (+6.82Z) LCX: NV |
Proximal LCx fusiform aneurysm (2.6 mm) | LCA bulbous aneurysmal bifurcation (3.6 mm), LAD (2.5 mm) with filling defect and RCA (1.7 mm) |
| 40. | 13 Y/M | CTCA carried out at presentation | LCA: 6.4 mm (+8.14Z) LAD: 4.7 (+6.3Z) RCA: 5.4 mm (+5.98Z) LCx: NV |
Proximal LCx fusiform dilatation and fusiform aneurysm (4.6 mm) at bifurcation involving OM1 branch | Fusiform aneurysms in LCA (6.3 mm), LAD (5.0 mm) and RCA (6.6 mm) |
| 41. | 8 Y/M | CTCA carried out at presentation | LCA: 3 mm (+0.8Z) LAD: 3 mm (+2.43Z) RCA: 3 mm (+1.45Z) LCx: 2 mm (−0.1Z) Diffuse dilation of LCA, LAD and RCA |
Distal LCx fusiform dilatation (3 mm) | Fusiform aneurysms in RCA (5.3 mm, 4.2 mm) and LAD (3.4 mm, 8.4 mm) |
CTCA: Computed tomography coronary angiography; LCA: Left main coronary artery; LAD: Left anterior descending coronary artery; LCx: Left circumflex coronary artery; OM: Osteoproximal; RCA: Right coronary artery.
a
TTE findings in follow-up at time of CTCA; NV: Not visualized on TTE; NA: values not available.