Follow-up assessment of the collateral circulation in patients with Kawasaki disease who underwent dipyridamole stress technetium-99m tetrofosmin scintigraphy.

To assess the alteration of myocardial ischemic findings and the role of collateral vessels in patients with Kawasaki disease (KD), we used dipyridamole stress technetium-99m tetrofosmin (Tf) single photon emission computed tomography (SPECT). A comparison study of coronary angiography and dipyridamole stress (0.70 mg/kg) Tf-SPECT was repeated at least twice in 20 patients. The subjects included 7 patients with coronary stenosis, 1 with pre- and post-coronary artery bypass grafting (CABG) due to coronary stenosis, 1 with progression to coronary stenosis, and 11 with persistent coronary aneurysms. In the stenosis group, Tf-SPECT revealed that 6 of the 7 patients had some degree of ischemic findings, and 5 of these 6 did not show any change in their ischemic findings during follow-up. In 1 patient, the ischemic findings changed according to the collateral circulation changes. The patient who underwent CABG had pre-CABG ischemic changes that disappeared after CABG. In the patient whose coronary arteries progressed to stenosis, the ischemic findings progressed as the coronary stenosis progressed. In the persistent aneurysm group, there were no ischemic findings. In the future Tf-SPECT may become one of the most useful methods for monitoring the progressive changes of myocardial ischemia in KD.

Energy expenditure of diplegic ambulation using flexible plastic ankle foot orthoses.

In order to determine whether flexible plastic ankle foot orthoses (AFOs) really have functional advantage for children with spastic diplegia (CP children). Six CP children (13.2 +/- 1.9 years) who showed moderate spasticity walked on a treadmill at relative speeds that ranged from slow to fast for three minutes at each speed. While walking with and without flexible plastic AFOs, oxygen uptake (VO2) was measured. Then an energy expenditure index (EEI) was calculated by taking the VO2 value divided by walking speed. A curve EEI-walking speed relationship was approximated to a parabolic curve. Then, the lowest value of EEI, as an economical EEI, was derived from the curve. In four of the six CP children, the EEI while walking with flexible plastic AFOs were larger than without flexible plastic AFOs. The economical EEI while walking with and without flexible plastic AFOs was 0.56 +/- 0.26 ml/kg/m and 0.42 +/- 0.14 ml/kg/m, respectively. The ambulation with flexible plastic AFOs required more energy than without flexible plastic AFOs (p < 0.05). From these results, flexible plastic AFOs do not seem to provide a functional advantage for CP children.

[Quantitative assessment of pulmonary regurgitation by two-dimensional Doppler color flow imaging: postoperative evaluation of patients with tetralogy of Fallot].

Pulmonary regurgitation (PR) is a serious event following surgical repair for tetralogy of Fallot. For quantitative assessments of PR using noninvasive methods, we performed Doppler color flow imaging in 38 children, whose ages ranged from three to 15 years. All images were obtained from one to 10 years after surgery. The right ventricle and pulmonary valve were demonstrated in the parasternal short-axis view. The images of PR flow were in red and were frozen when the area of a signal was maximum (early to mid diastole). The PR distance index (PRDI), which is the maximum PR flow distance divided by square root of the body surface area, was measured. The PR area index (the maximum PR flow area/body surface area) (PRAI) was also calculated using a track ball. Cardiac catheterization was performed for 12 patients without residual L-R shunts or any apparent tricuspid regurgitation. PR was graded (0 = absent, 1 = trivial, 2 = mild, 3 = moderate, 4 = severe) according to the projection of contrast medium in the right ventricle as seen on the main pulmonary arteriogram. The size of the right ventricle was expressed as the right ventricular end-diastolic volume (RVEDV; % of normal), as determined from the cineangiogram, and the tricuspid valve annulus diameter (TVD; % of normal) from a four-chamber view of the two-dimensional echocardiogram. There were significant differences between the PRDI and the PRAI of five patients with PR of grades 1-2 and those of seven patients with PR of grade 3-4 (p less than 0.01, p less than 0.01, respectively). There was significant correlation between the % RVEDV and the % TVD observed (r = 0.82, p less than 0.01). Significant negative correlations were observed between the PRDI and right ventricular ejection fraction (RVEF), and the PRAI and RVEF (r = -0.68, p less than 0.02; r = -0.82, p less than 0.01, respectively). RVEF was below normal in all seven patients (100%) with PR of grade 3 or more and in one of five patients (20%) with PR of grade 2 or less. The PRDI of 2.5 or more, or the PRAI of 4.0 or more was equivalent to a PR of grade 3 or more and was a reliable index of significant PR.(ABSTRACT TRUNCATED AT 400 WORDS)