Abstract
OBJECTIVE—To determine the sensitivity and specificity of our transthoracic echocardiographic technique using high frequency (7.5 MHz) transducers for identification of the presence and type of coronary artery disease in patients with Kawasaki disease. DESIGN—The results of the prospective echocardiographic study in each of seven segments of the four major coronary arteries were compared with the selective coronary angiograms. SETTING—Kitasato University Hospital. SUBJECTS—60 patients with Kawasaki disease, ranging in age from 8.0 months to 22 years (median, 6.0 years). RESULTS—Adequate echocardiographic images were obtained in 397 (95%) of 420 coronary segments. Coronary angiography showed the presence of coronary aneurysms in 87 segments and stenosis or occlusion in 28. The overall sensitivity and specificity of cross sectional echocardiography for correctly identifying coronary aneurysms were 95% and 99%, respectively; for correctly identifying coronary stenosis or occlusion the values were 85% and 98% for the right coronary artery, and 80% and 97% for the left anterior descending coronary artery. Agreement on the presence or absence of coronary aneurysms and obstructive lesions on echocardiograms between the two observers was 1.0 and 0.98, respectively. CONCLUSIONS—Echocardiography may provide a non-invasive means of identifying the presence and type of coronary artery disease in patients with Kawasaki disease. Keywords: Kawasaki disease; coronary artery aneurysm; coronary artery stenosis; echocardiography
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Figure 1 .
Upper panel: selective right coronary angiogram showing a fusiform aneurysm at the proximal to mid portions of the right coronary artery (segments 1 and 2) and a saccular aneurysm of the distal portion (segment 3) in a one year old boy. Lower panels: cross sectional echocardiograms from the same patient, showing good correspondence with the angiogram. The left and right images were obtained from modified subcostal views and the middle image from a modified apical view. AN, aneurysm; RCA, right coronary artery.
Figure 2 .
Left panel: selective left coronary angiogram showing a fusiform aneurysm at the left main and proximal left anterior descending coronary arteries in a six year old girl. Right panels: cross sectional echocardiograms from the same patient showing good correspondence with the angiogram. The four panels (A, B, C, D) show images of segments 4, 5, 6, and 7, respectively. AO, aorta; LA, left atrium; LAD, left anterior descending coronary artery; LM, left main coronary artery; LCX, left circumflex artery; LV, left ventricle; RV, right ventricle.
Figure 3 .
Upper panel: selective right coronary angiogram shows segmental stenosis (a bridging lesion; arrowheads) in the proximal right coronary artery (Pro RCA) in a 20 year old man. Lower panels: echocardiograms from the same patient; left and middle panels: proximal right coronary artery (Pro RCA) showed abrupt separation into two smaller vessels; right panel: another abnormal vessel (arrowhead) was viewed by more leftward-inferior angling of the transducer than the plane recorded for the middle panel. These were judged to be bridging vessels connecting the site of an occlusion.
Figure 4 .
Upper panels: selective left coronary angiograms before and after intracoronary thrombolytic treatment in a one year old boy, showing partial thrombolysis within the aneurysm of the proximal left anterior descending coronary artery (LAD). Lower panels: serial cross sectional echocardiograms from the same patient. The left and middle panels show images before and one hour after intracoronary thrombolytic treatment. The right panel is the echocardiogram done one day after thrombolytic treatment.
Selected References
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