Circulation, Vol 89, 258-265, Copyright © 1994 by American Heart Association
T Sugimura, H Kato, O Inoue, T Fukuda, N Sato, M Ishii, J Takagi, T Akagi, Y Maeno and T Kawano
BACKGROUND: The long-term clinical issue in Kawasaki disease (KD) concerns
the coronary artery lesion. Two-dimensional echocardiography and coronary
angiography are routine examinations to evaluate the coronary lesions;
however, these are not adequate to assess the wall morphology of the
coronary artery (CA). Intravascular ultrasound imaging (IVUS), a new
technology for the evaluation of the coronary artery lumen and wall
morphology in vivo, was performed for patients after KD in their long-term
follow-up, and we examined the new insights it gave. METHODS AND RESULTS:
IVUS was performed during cardiac catheterization in 20 subjects (10
patients after KD who still had coronary aneurysms or regressed coronary
aneurysms, 2 after KD who had no coronary abnormal lesion, and 8 control
patients with congenital heart disease and normal CA). We evaluated the
wall structure at 10 to 15 sites of the CA in each patient. IVUS was
performed with a commercially available ultrasound imaging catheter. Four
sites of a CA aneurysm in KD demonstrated a markedly dilated lumen without
thickened intima. One site of a CA aneurysm with calcification demonstrated
an asymmetrical lumen by a dense echo with acoustic shadows. Twenty-two
sites of a regressed CA aneurysm demonstrated a marked symmetrical or
asymmetrical thickening of the intima with a dense echo, in which the size
of the lumen was similar to that at a site near a regressed aneurysm. The
sites of angiographically normal CA revealed normal structures and a thin
intima in many instances. Nine of 28 sites in KD with a CA abnormal lesion,
particularly near a coronary aneurysm or regressed aneurysm, demonstrated a
mild thickening of the intima. All the 10 sites in KD without a CA abnormal
lesion and all the 25 sites in patients with congenital heart disease with
normal CA demonstrated a smooth intima. CONCLUSIONS: This study
demonstrated that the site of a regressed coronary aneurysm has a markedly
thickened but smooth intima. The sites of angiographically normal CA after
KD with or without a coronary lesion demonstrated normal IVUS findings in
most instances but in some cases revealed a mild intimal thickening. IVUS
is useful to evaluate the CA wall morphology and may contribute to the
assessment of long-term CA sequelae and the possible development of
arteriosclerotic changes in KD.
ARTICLES
Intravascular ultrasound of coronary arteries in children. Assessment of the wall morphology and the lumen after Kawasaki disease
Department of Pediatrics, Kurume University School of Medicine, Japan.
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