Transthoracic ultrasonic visualisation of coronary aneurysm, stenosis, and occlusion in Kawasaki disease
S Hiraishi, H Misawa, N Takeda, Y Horiguchi, N Fujino, N Ogawa, H Hirota
Department of Paediatrics, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228, Japan
Correspondence to: Dr Hiraishi Accepted 9 November 1999
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 Kawasakidisease.
DESIGN
The results of the prospective echocardiographic study in each of seven segments of the four major coronary arteries werecompared 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.
(Heart 2000;83:400-405)
Keywords: Kawasaki disease; coronary artery aneurysm; coronary artery stenosis; echocardiography
References
1. Pahl E, Ettedgui J, Neches WH, et al. The value of angiography in the follow-up of coronary involvement in mucocutaneous lymph node syndrome (Kawasaki disease). J Am Coll Cardiol 1989;14:1318-1325[Medline].
2. Suzuki A, Kamiya T, Ono Y, et al. Follow-up study of coronary artery lesions due to Kawasaki disease by serial selective coronary arteriography in 200 patients. Heart Vessels 1987;3:159-165[Medline].
3. Capannari TE, Daniels SR, Meyer RA, et al. Sensitivity, specificity and predictive value of two-dimensional echocardiography in detecting coronary artery aneurysms in patients with Kawasaki disease. J Am Coll Cardiol 1986;7:355-360[Medline].
4. Kenny A, Fuller CA, Cary NRB, et al. Histopathological validation of high frequency epicardial echocardiography of the coronary arteries in vitro. Br Heart J 1991;65:326-331[Abstract].
5. Weyman AE, Feigenbaum H, Dillon JC, et al. Noninvasive visualization of the left main coronary artery by cross sectional echocardiography. Circulation 1976;54:169-174[Abstract].
6. Saito A, Ueda K, Nakano H. Two-dimensional echocardiographic visualization of the peripheral right coronary artery in patients with mucocutaneous lymph node syndrome. J Cardiogr 1982;12:401-413[Medline].
7. Douglas PS, Fiolkoski J, Berko B, et al. Echocardiographic visualization of coronary artery anatomy in the adult. J Am Coll Cardiol 1988;11:565-571[Medline].
8. Vieweg WVR, Alpert JS, Hagan CAD. Caliber and distribution of normal coronary arterial anatomy. Cathet Cardiovasc Diagn 1976;2:269-280[Medline].
9. Kamiya T, Kawasaki T, Okuni M, et al. Diagnostic criteria of cardiovascular lesions in Kawasaki disease. Research Committee on Kawasaki Disease Ministry of Health and Welfare. Tokyo: Japanese Ministry of Health and Welfare, 1984;1-10.
10. Arjunan K, Daniels SR, Meyer RA, et al. Coronary artery caliber in normal children and patients with Kawasaki disease but without aneurysms: an echocardiographic and angiographic study. J Am Coll Cardiol 1986;8:1119-1124[Medline].
11. Nakano H, Ueda K, Saito A, et al. Repeated quantitative angiograms in coronary arterial aneurysm in Kawasaki disease. Am J Cardiol 1985;56:845-851.
12. Oberhoffer R, Lang D, Feilen K. The diameter of coronary arteries in infants and children without heart disease. Eur J Pediatr 1989;148:389-392[Medline].
13. Presti CF, Feigenbaum H, Armstrong WF, et al. Digital two-dimensional echocardiographic imaging of the proximal left anterior descending coronary artery. Am J Cardiol 1987;60:1254-1259[Medline].
14. Ross JJ, Mintz GS, Chandrasekaran K. Transthoracic two-dimensional high frequency (7.5 MHz) ultrasonic visualization of the distal left anterior descending coronary artery. J Am Coll Cardiol 1990;15:373-377[Medline].
15. Kenny A, Shapiro LM. Transthoracic high-frequency two-dimensional echocardiography, Doppler and color flow mapping to determine anatomy and blood flow patterns in the distal left anterior descending coronary artery. Am J Cardiol 1992;60:1265-1268.
16. Fujiwara T, Fujiwara H, Ueda T, et al. Comparison of macroscopic, postmortem, angiographic and two-dimensional echocardiographic findings of coronary aneurysms in children with Kawasaki disease. Am J Cardiol 1986;57:761-764[Medline].
17. Yanagisawa M, Yano S, Shiraishi H, et al. Coronary aneurysms in Kawasaki disease: follow-up observation by two-dimensional echocardiography. Pediatr Cardiol 1985;6:11-16[Medline].
18. Minich LL, Tani LY, Pagotto LT, et al. Usefulness of echocardiography for detection of coronary artery thrombi in patients with Kawasaki disease. Am J Cardiol 1998;82:1143-1146[Medline].
19. Naoe S, Shibuya K, Takahashi K, et al. Pathological observations concerning the cardiovascular lesions in Kawasaki disease. Cardiol Young 1991;1:212-220.
20. Samdarshi TE, Nanda NC, Gatewood RP, et al. Usefulness and limitations of transesophageal echocardiography in the assessment of proximal coronary artery stenosis. J Am Coll Cardiol 1992;19:572-580[Medline].
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