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

doi:10.1016/0002-9149(86)90609-0

The American Journal of Cardiology

Volume 57, Issue 10, 1 April 1986, Pages 761-764

https://doi.org/10.1016/0002-9149(86)90609-0 Get rights and content

Abstract

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.

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Although myocardial perfusion imaging has utility in assessing coronary artery supply to the myocardium, it is not considered sufficient in isolation to support or exclude the diagnosis of KD. Coronary artery angiography is the gold standard for coronary artery assessment, especially if there is evidence of ischaemia [81,82]. Angiography is better than echocardiography particularly in detecting distal coronary artery lesions [69,70].
Linear shadows inside coronary arterial lesions on two-dimensional echocardiograhpy in Kawasaki disease patients
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Conventional two-dimensional echocardiography (2DE) is not adequately sensitive enough for the detection of stenotic or occlusive coronary lesions that occur in Kawasaki disease. Recently, linear shadows have been detected inside large- or moderate-sized coronary artery lesions (CALs) by high-resolution 2DE at a convalescent or chronic stage.
We evaluated the clinical significance of the linear shadows detected by 2DE and compared the findings with those obtained using coronary angiography (CAG), magnetic resonance imaging (MRI), and intravascular ultrasound (IVUS).
From December 2001 to November 2006, linear shadows were detected in 11 out of 18 CALs in 9 patients at our institution. The outer diameters of the CALs by 2DE were larger than the diameters of CALs by CAG, while the inner diameters between the linear shadows by 2DE correlate with the diameters of CALs by CAG. Remarkably thickened intima was confirmed in 7 out of 9 CALs by MRI, and in every lesion that was examined using IVUS.
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1996, Journal of the American College of Cardiology
This study was designed to assess the feasibility and diagnostic accuracy of dobutamine stress echocardiography for detection of coronary artery stenosis in children with Kawasaki disease.
Dobutamine stress echocardiography is valuable as an alternative test for detection of coronary artery disease in adult patients; however, its usefulness for children has been demonstrated only in limited cases.
Dobutamine stress echocardiography (up to 30 μg/kg body weight per min) was performed in 50 patients at the convalescent stage of Kawasaki disease, including 26 patients with coronary sequelae documented by previous coronary angiography (sequelae group, 3 to 15 years old) and 24 patients with normal coronary arteries documented by echocardiography (normal group, 7 to 16 years old), who underwent quantitative coronary angiography on a separate day. Left ventricular regional wall motion divided into 16 segments was assessed in relation to the extent of coronary artery disease. A positive test response was defined as a new or worsened wall motion abnormalities.
Significant coronary artery disease (≥50% diameter stenosis of major vessels) was present in 21 patients in the sequelae group. There was no significant difference in the maximal dose of dobutamine between the sequelae and normal groups ([mean ± SD] 22.4 ± 5.1 vs. 24.2 ± 2.5 μg/kg per min). Heart rate and systolic blood pressure were significantly increased (p < 0.01) at maximal dose of dobutamine compared with values at rest in both groups; consequently, the rate-pressure product exceeded 20,000 in 20 (40%) of the 50 patients during dobutamine infusion. Ten patients had self-limiting side effects; however, there were no serious complications from stress-induced ischemia. New wall motion abnormalities corresponding to the extent of coronary artery disease were detected in 19 of 21 patients in the sequelae group, whereas no wall motion abnormalities were detected in the normal group. Thus, the sensitivity and specificity of dobutamine stress echocardiography for the detection of coronary artery disease were 90% and 100%, respectively.
We conclude that dobutamine stress echocardiography is a safe and accurate diagnostic method for detection of coronary artery stenosis in Kawasaki disease. Moreover, this is a possible alternative method for patients unable to exercise adequately, even if they are small children.
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Intraobserver variability for percent area change measurements was 2.8 ± 0.9% and 3.8 ±1% for observers 1 and 2, respectively. The mean interobserver difference of regional percent area change was 4.7 ± 1.8%. Normal values for the eight anatomic segments were established in each echocardiographic imaging plane. The overall results were independent of the type of reference system utilized. The subcostal views yielded different results from their parasternal counterparts, probably because of differing imaging planes. These normal values establish a data base in the pediatric age range that can be used to detect abnormal segments in children at risk for developing regional left ventricular wall motion abnormalities.

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^☆: This study was supported in part by a grant for scientific research from Kyoto Women's University, Kyoto, Japan, and by a research grant from the Ministry of Health and Welfare of the Japanese government, Tokyo, Japan.

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

Abstract

Am Heart J

Am J Cardiol

Am J Cardiol

A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan

Pediatrics