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La enfermedad de Kawasaki (EK) es la principal causa de cardiopatía adquirida en menores de cinco años. Nuestro objetivo fue conocer las características clínicas, el compromiso coronario y la evolución de pacientes atendidos en nuestra institución. Se revisó una serie de casos desde 2001 hasta 2018. Se incluyeron 63 pacientes, 58 % varones; la mediana de edad fue 2,6 años. La mediana de días de fiebre al diagnóstico fue 5,5 días. El 33 % presentó la forma incompleta y se detectó compromiso coronario en el 20 %. El 60 % de los pacientes con afectación coronaria presentaron EK incompleta versus el 28 % de presentación incompleta en los pacientes sin compromiso coronario (p 0,06). No se observaron diferencias en datos de laboratorio entre los grupos según el compromiso coronario. En conclusión, 33 % presentó EK incompleta y el 20 %, afectación coronaria. Hubo una tendencia de mayor riesgo para daño coronario en la forma incompleta.
Kawasaki disease (KD) is considered the leading cause of acquired heart disease in children younger than 5 years. Our objective was to know the clinical characteristics, coronary involvement, and course of patients seen at our facility. A case series from 2001 to 2018 was reviewed. Sixty-three patients were included; their median age was 2.6 years; 58% were males. The median duration of fever at the time of diagnosis was 5.5 days. The incomplete form was observed in 33% and coronary involvement, in 20%. Among patients with coronary involvement, 60% had incomplete KD versus 28% among those without coronary involvement (p: 0.06). No differences were observed between groups in laboratory data based on coronary involvement. To conclude, 33% had incomplete KD and 20%, coronary involvement. There was a trend to a higher risk for coronary artery damage in the incomplete form of KD.
Subject(s)
Humans , Child, Preschool , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/epidemiology , Retrospective Studies , Immunoglobulins, Intravenous , Fever , Hospitals, GeneralABSTRACT
A 73-year-old woman was diagnosed with coronary artery aneurysms associated with coronary-pulmonary arterial fistula in a preoperative examination for transverse colon cancer. One of the aneurysms (28 mm) originated from a branch of the right coronary artery and the other two (16 and 12 mm) originated from a branch of the left coronary artery. We performed surgery to prevent their rupture because the right coronary artery aneurysm showed a tendency to enlarge. Surgery was performed through a median sternotomy under cardiopulmonary bypass. Suture closure of the inflow and outflow of the aneurysm was performed. The coronary-pulmonary arterial fistula was ligated. In addition, suture closure of the outflow of the coronary-pulmonary artery fistula into the pulmonary artery was performed, under direct view after incision of the pulmonary trunk. No residual shunt blood flow in the coronary-pulmonary arterial fistula was observed on postoperative echocardiography. Furthermore, no coronary aneurysm and coronary-pulmonary arterial fistula was recognized on postoperative coronary computed tomography. The patient made an uneventful recovery and was discharged from the hospital on postoperative day 12.
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Objective To describe various infectious triggers for Kawasaki disease (KD) in India. Methods A series of 10 children with diagnosed infections who developed KD during their course of illness has been presented. They were diagnosed by the American Heart Association (AHA) 2017 guidelines. Echocardiography was done to check for coronary artery dilation. Treatment was instituted as per standard protocol. Results Kawasaki disease was diagnosed in 8 boys and 2 girls, aged 1 mo to 11 y. These children were being treated for dengue, chikungunya, SARS-CoV-2, hepatitis A, tuberculosis, brucellosis, disseminated staphylococcal sepsis, scrub typhus, and enteric fever. Conclusions Kawasaki disease has been associated with infectious triggers. It should be considered in febrile patients with mucocutaneous involvement or in nonresponsive sepsis, despite adequate therapy.
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Objective:To investigate the clinical manifestations, diagnosis, treatment and prognosis of Kawasaki disease (KD) complicated with acute abdomen in children.Methods:Clinical manifestations, laboratory examinations, abdominal B-ultrasound scans, abdominal plain films, abdominal CT findings, coronary artery lesions and prognosis of 16 children with KD and acute abdomen admitted to Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from August 1, 2015 to July 31, 2019 were retrospectively analyzed.The measurement data of age, leukocyte, hemoglobin, platelet and biochemical indexes are expressed by M (range). Results:A total of 16 cases were included, involving 7 males and 9 females aged 4 years and 8 months (7 months to 8 years). Among them, 9 cases of KD complicated with cholecystitis, 5 cases with intestinal obstruction, 2 cases with acute appendicitis, 2 cases with necrotizing enterocolitis, 2 cases with acute peritonitis and 1 case with acute pancreatitis.There were 3 cases complica-ted with 2 or more kinds of acute abdomen diseases.All 16 patients had symptoms of abdominal pain, 7 cases had vomiting, 4 cases had obvious abdominal distension and 1 case had bloody stool.Abdominal B-ultrasound was performed in all cases, and 8 cases showed enlargement of gallbladder and edema and thickening of gallbladder wall, 2 cases of appendicitis, 2 cases of intestinal obstruction and 1 case of pancreatic enlargement.Abdominal plain film examination was performed in 8 cases, suggesting necrotizing enterocolitis in 2 cases and intestinal obstruction in 2 cases.Abdominal CT examination was performed in 3 cases, including edema of gallbladder wall in 1 case, peritonitis in 1 case, intestinal obstruction in 2 cases and enlargement of pancreas in 1 case.All the 16 cases were treated with pulsed intravenous immunoglobulin (IVIG) at 2 g/kg and antiplatelet agents.Eight IVIG-resistant cases were treated with the second dose of IVIG at 2 g/kg, among whom, 4 children still had fever and intravenous Methylprednisone was given.Two cases underwent enterostomy and abdominal puncture drainage.All the 16 children were followed up until 6 months after discharge, and 4 cases (25%) were complicated with coronary artery aneurysm (CAA) during the acute stage or follow-up period.Conclusions:KD complicated with acute abdomen is more commonly manifested as cholecystitis and intestinal obstruction.Besides the classic symptoms of KD, abdominal pain and vomiting are the most common in KD with acute abdomen.Abdominal ultrasound, plain film and CT examinations are conductive to the early diagnosis of KD complicated with acute abdomen.In addition, the incidence of IVIG-resistance and CAA is relatively high in children with KD complicated with acute abdomen.
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We present herein the case of a 45-year-old man with a coronary artery aneurysm (diameter 19 mm) in the proximal part of the left anterior descending branch associated with eosinophilic granulomatosis with polyangiitis (EGPA). As coronary angiography showed #6 : 100% and #12-2 : 90%, and Tc-99 m myocardial scintigraphy showed exertional ischemia in the anterior septum, revascularization was considered to be indicated. Prednisolone and mepolizumab were administered preoperatively to suppress the activity of vasculitis due to eosinophilia, and surgery was performed when the eosinophil count normalized. The patient underwent off-pump coronary artery bypass grafting (LITA-LAD, SVG-OM2). The patient was discharged, and the postoperative course was uneventful. In coronary artery bypass grafting for EGPA, eosinophils may infiltrate the internal thoracic artery and result in vasculitis, which may affect the patency rate. Perioperative management of vasculitis may thus be important.
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INTRODUCCION: El Síndrome Inflamatorio Pediátrico Multisistémico (PIMS) ha emergido como una nueva enfermedad en niños, secundaria a infección por SARSCoV-2. Se caracteriza por presentar compromiso multiorgánico con parámetros inflamatorios elevados y manifestaciones clínicas graves, siendo el corazón el órgano más severamente comprometido. OBJETIVO: Describir las características clínicas y de laboratorio de 23 pacientes con diagnóstico de PIMS con compromiso cardiovascular hospitalizados en un centro único. MÉTODO: Se efectuó un estudio retrospectivo analizando los hallazgos clínicos y de laboratorio junto a las manifestaciones cardiovasculares que presentaron estos pacientes. RESULTADOS: 23/29 pacientes con PIMS (78%) presentaron manifestaciones digestivas y mucocutáneas. Las manifestaciones cardiovasculares fueron: Síndrome Kawasaki y "Kawasaki like" sin compromiso coronario en 15/23 (65%) y con compromiso coronario en 3 (13%). Shock en 9 pacientes (39%), injuria miocárdica- miocarditis en 8 (35%) y derrame pericárdico en 13 (56%). Trastornos del ritmo cardíaco se observaron en 6 pacientes (26%). La terapia más utilizada fue inmunoglobulina y corticoides. 18 /23 requirieron manejo en unidades de intermedio y/o intensivo. Un 70% de los pacientes se recuperó del compromiso cardiovascular antes del alta. CONCLUSIÓN: El compromiso cardiovascular en PIMS es la complicación más frecuente de esta enfermedad, que se acompaña de manifestaciones inmunológicas y hematológicas graves lo que hace necesario un tratamiento multidisciplinario para un mejor manejo de estos pacientes.
INTRODUCTION: Pediatric Multisystemic Inflammatory Syndrome (PIMS) has emerged as a new disease in children, secondary to SARSCoV-2 infection. It is characterized by multi-organ involvement with elevated inflammatory parameters and severe clinical manifestations, the heart being the organ most severely involved. OBJETIVE: to describe the clinical and laboratory characteristics of 23 patients diagnosed with PIMS with cardiovascular involvement hospitalized in a single center. METHOD: We conducted a retrospective study in which we analyzed the clinical and laboratory findings along with the cardiovascular manifestations presented by these patients. Results: 23/29 patients with PIMS and cardiovascular involvement were selected, 78% had digestive and mucocutaneous manifestations. Cardiovascular manifestations consisted of KawasakiKawasaki like syndrome without coronary involvement in 15/23 (65%) and coronary involvement in 3 (13%). Nine patients developed shock (39%), 8 (35%) myocardial injury in and 13 (56%) pericardial effusion.. Heart rhythm disorders were observed in 6 patients (26%). The main therapy was immunoglobulin and corticosteroids. 18 /23 required management in intermediate and/or intensive care unit. 70% of patients recovered from cardiovascular involvement before discharge. CONCLUSION: Cardiovascular involvement in PIMS is the most frequent complication of this disease, but it is associated with severe immunological and hematological manifestations, which makes necessary a multidisciplinary treatment for a better management
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Cardiovascular Diseases/etiology , Cardiovascular Diseases/epidemiology , Systemic Inflammatory Response Syndrome/complications , COVID-19/complications , Coronary Aneurysm/etiology , Coronary Aneurysm/epidemiology , Echocardiography , Chile , Retrospective Studies , Age Distribution , SARS-CoV-2 , Heart Injuries/etiology , Heart Injuries/epidemiology , Hospitalization , Mucocutaneous Lymph Node Syndrome/etiology , Mucocutaneous Lymph Node Syndrome/epidemiologyABSTRACT
A 53-year old female was noted to have an enlarged heart on a medical checkup. A multislice computed tomography study demonstrated a giant coronary artery aneurysm measuring 10 cm in diameter and a coronary arteriovenous fistula, both located below the left atrium. Resection of the aneurysm and ligation of the feeding arteries and arteriovenous fistula were performed under cardiopulmonary bypass. As the native coronary sinus was occluded, we reconstructed the vessels draining from the aneurysm into the right atrium with an autologous pericardial patch to preserve the coronary venous blood flow. To our knowledge this is the first report of an autologous pericardial patch being successfully used to reconstruct the coronary venous flow during surgical treatment of a giant coronary artery aneurysm with a coronary arteriovenous fistula.
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An unconscious 79-year-old woman was admitted. Echocardiography showed cardiac tamponade with pericardial effusion. Enhanced computed tomography revealed pericardial effusion and a coronary artery aneurysm (maximum diameter of 16 mm) on the left side of the main pulmonary artery. Emergency coronary angiography confirmed the aneurysm, which originated from a branch of the left anterior descending artery. Emergency surgery was performed through median sternotomy with cardiopulmonary bypass. After cardiac arrest by antegrade cardioplegia, the aneurysm was opened and two orifices of the arteries were observed. The orifices were ligated, and the remaining aneurysmal wall was closed with a continuous suture. A pathological examination of the aneurysmal wall demonstrated an atherosclerotic true aneurysm.
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A 62-year-old man with Marfan syndrome had a modified Bentall procedure and total arch replacement for annuloaortic ectasia, aortic insufficiency and thoracic aortic aneurysm fifteen years ago at another hospital. A follow-up CT revealed bilateral coronary artery aneurysms and an aortic root pseudoaneurysm, and thus he was referred to our hospital. The previous prosthetic valve was removed, followed by the re-Bentall procedure. Coronary artery aneurysms were resected and consequently coronary arteries were reconstructed directly. Although the shortcoming of the Bentall procedure was pseudoaneurysm, the outcomes of the modified Bentall procedure have shown some improvements. However, as there is still a high risk of postoperative complication in connective tissue diseases, long-term follow-up is required.
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Objective@#To investigate the characteristics of long-term changes in giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD) and the technical approach of using selective coronary angiography (SCAG) in children.@*Methods@#A retrospective analysis was made in 52 patients with KD and GCAA in acute phase, including 38 males and 14 females with an average age of (4.1±2.5) years old ranging from 1 to 14 years old, from January 2008 to December 2018 at the Department of Cardiology, Guangzhou Women and Children′s Medical Center.The selective coronary angiography (SCAG) was performed in the patients who were followed up for (10.6±3.6) years (1-19 years). The changes in coronary artery lesions were analyzed and the technical approach of SCAG was discussed in children.@*Results@#Among 52 patients investigated by SCAG, the location of coronary artery lesion was found the left-anterior descending branch in 21 cases(40.4%), 20 cases(38.5%) in the right coronary artery, 8 cases(15.4%) in the left main trunk and 3 cases(5.7%) in circumflex.The left coronary artery in 2 cases and the right coronary artery in 4 cases were completely occluded, and collateral vessel formation was found in 12 cases.There were 21 cases of right coronary artery stenosis, including 7 cases of the right coronary artery occlusion and bridge-like neovascularization, and 4 cases of the right coronary artery woven lesions (thrombotic occlusion and clustered neovascularization). There were 27 cases of the left coronary artery stenosis with different degrees, including 5 cases of the left coronary artery occlusion and bridge-like neovascularization, and 2 cases of the left coronary artery woven lesions (thrombotic occlusion and clustered neovascularization). All of 52 patients with GCAA were followed up for 1 to 19 years.GCAA still existed in 40 cases.Regression to small coronary artery aneurysm was found in 8 cases, and mild-dilation regression was observed only in 4 patients.The resting electrocardiogram showed pathological Q wave and the left ventricular enlargement in 6 cases, and normal in the remaining 46 patients.The children had no subjective symptoms and their activities were not restricted.Compared with SCAG, echocardiography detected 52 cases with proximal morphological changes in the coronary artery, but distal changes were found only in 3 cases.And 12 cases with coronary artery occlusion and neovascularization failed to be prompted by echocardiography.@*Conclusions@#GCAA induced by KD can persist for a long time, and has characteristics of coronary occlusion, stenosis, and collateral vessel formation.The conventional electrocardiogram and echocardiography are insensitive to the coronary artery morphology and dysfunction in KD sequelae.The SCAG is of great value in tracking this disease.For using SCAG in children, as long as the approp-riate equipment and projection angle are selected, and the operation skills are mastered, satisfactory images and high success rate can be obtained.
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Objective@#To investigate the safety and efficacy of Warfarin combined with Aspirin in the treatment of multiple medium and giant coronary artery aneurysms in Kawasaki disease(KD).@*Methods@#Clinical and follow-up data of 45 children diagnosed with KD complicated with multiple medium-sized and giant coronary artery aneurysms from April 2014 to December 2018 at Guangzhou Women and Children′s Medical Center were collected.These children were divided into 2 groups.A total of 31 cases received regular oral Warfarin combined with Aspirin called experimental group.There were 14 patients treated with oral Aspirin and Clopidogrel called control group.General information, laboratory examination, electrocardiogram, echocardiography, outcome and bleeding complications of the 2 groups were analyzed retrospectively.@*Results@#(1) In experimental group, there were 22 patients found thrombosis under echocardiography.The 10 patients′ thrombosis disappeared, 5 patients′ thrombosis reduced, and 2 patients′ increased after treatment.In control group, there were 5 cases found thrombosis.The 2 cases′ thrombosis reduced and 3 cases′ throm-bosis increased.The number of thrombosis in experimental group was significantly reduced, and the number of new thrombosis was less than that in control group (χ2=6.454, P<0.05). (2) The number of coronary artery aneurysms in experimental group increased slowly than that in control group [12.90%(4/31 cases)vs.14.28%(2/14 cases)]. (3) The number of coronary artery aneurysms in experimental group decreased rapidly than that in control group [23.91%(11/46 cases)vs.10.00%(1/10 cases)]. (4) The number of cases of tumor retraction in experimental group was more than that in control group [74.19%(23/31 cases)vs.42.85%(6/14 cases)]. (5) During the followed-up, there was no abnormality in the blood phosphokinase isozyme and troponin, no abnormality in the electrocardiogram and echocardiogram, no ventricular enlargement and abnormal ventricular wall movement, and the ejection fraction value was within the normal range.No active bleeding and no death occurred in the two groups.@*Conclusions@#Warfarin combined with Aspirin is very safe and effective in the treatment of KD coronary tumor, it can reduce thrombosis effectively.Compared with oral Aspirin and Clopidogrel, Warfarin combined with Aspirin can reduce the number of multiple medium-sized and large coronary artery aneurysms and reduce the diameter of coronary artery aneurysms.
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Objective@#To investigate the status of uncertainty in illness and its influencing factors among parents of children with Kawasaki disease complicated by coronary artery aneurysm.@*Methods@#A total of 102 parents of children with Kawasaki disease complicated by coronary artery aneurysms were investigated by General Information Questionnaire, Parent's Perception of Uncertainty Scale, Hospital Anxiety and Depression Scale.@*Results@#The total sore of Parent′s Perception of Uncertainty Scale was (91.02 ± 13.14) points; that of anxiety was (14.35 ± 3.93) points; while that of depression was (13.81 ± 3.92) points. The uncertainty in illness among parents was influenced by coronary artery aneurysm grading, source of medical expenses, education level, understanding of the disease, average family income (F=2.535-8.740, all P<0.05), relationship with the child, work status (t =2.057, -2.489, P<0.05). Multiple stepwise regression analysis showed that depression, understanding of the disease, source of medical expenses had a significant impact on the illness uncertainty of parents (F=13.695, P<0.05).@*Conclusions@#The uncertainty in illness among parents of children with Kawasaki disease complicated by coronary artery aneurysm had a higher level. The doctors and nurses should pay attention to the effect of uncertainty in illness on the parents of children and take targeted intervention measures to help parents reduce uncertainty in illness, thereby improving the quality of life.
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Objective To investigate the status of uncertainty in illness and its influencing factors among parents of children with Kawasaki disease complicated by coronary artery aneurysm. Methods A total of 102 parents of children with Kawasaki disease complicated by coronary artery aneurysms were investigated by General Information Questionnaire, Parent′s Perception of Uncertainty Scale, Hospital Anxiety and Depression Scale. ResuLts The total sore of Parent′s Perception of Uncertainty Scale was (91.02 ± 13.14) points; that of anxiety was (14.35 ± 3.93) points; while that of depression was (13.81 ± 3.92) points. The uncertainty in illness among parents was influenced by coronary artery aneurysm grading, source of medical expenses, education level, understanding of the disease, average family income (F=2.535-8.740, all P<0.05), relationship with the child, work status (t=2.057,-2.489, P<0.05). Multiple stepwise regression analysis showed that depression, understanding of the disease, source of medical expenses had a significant impact on the illness uncertainty of parents (F=13.695, P<0.05). ConcLusions The uncertainty in illness among parents of children with Kawasaki disease complicated by coronary artery aneurysm had a higher level. The doctors and nurses should pay attention to the effect of uncertainty in illness on the parents of children and take targeted intervention measures to help parents reduce uncertainty in illness, thereby improving the quality of life.
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Kawasaki disease ( KD) is an acute febrile illness that preferentially affects children youn-ger than 5 years old and the primary cause of acquired heart disease during childhood. Coronary artery aneu-rysms ( CAA) is a serious complication of KD, leading to ischemic heart disease, myocardial infarction, and sudden cardiac death. Timely initiation of treatment with intravenous immunoglobulin ( IVIG) has reduced the incidence of CAA from 25％ to 4％. Nitrogen-terminal B-type natriuretic peptide ( NT-proBNP ) , originally used for the management of adults with heart disease, was shown to be useful in the diagnosis and management of patients with KD. NT-proBNP is released by cardiomyocytes in response to mechanical factors, such as the dilation of cardiac chambers, and to pro-inflammatory cytokines. Patients with KD have higher NT-proBNP at the time of diagnosis than febrile controls. Moreover, patients with resistance to IVIG treatment and CAA were found to have higher levels of NT-proBNP, suggesting a prognostic role. This review summarizes the signifi-cance of NT-proBNP in the diagnostic value of KD in recent years.
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Objective To investigate the characteristics of long-term changes in giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD) and the technical approach of using selective coronary angiography (SCAG) in children.Methods A retrospective analysis was made in 52 patients with KD and GCAA in acute phase,including 38 males and 14 females with an average age of (4.1 ±2.5) years old ranging from 1 to 14 years old,from January 2008 to December 2018 at the Department of Cardiology,Guangzhou Women and Children's Medical Center.The selective coronary angiography (SCAG) was performed in the patients who were followed up for (10.6 ± 3.6) years (1-19 years).The changes in coronary artery lesions were analyzed and the technical approach of SCAG was discussed in children.Results Among 52 patients investigated by SCAG,the location of coronary artery lesion was found the left-anterior descending branch in 21 cases(40.4％),20 cases(38.5％) in the right coronary artery,8 cases (15.4％) in the left main trunk and 3 cases(5.7％) in cimumflex.The left coronary artery in 2 cases and the right coronary artery in 4 cases were completely occluded,and collateral vessel formation was found in 12 cases.There were 21 cases of right coronary artery stenosis,including 7 cases of the right coronary artery occlusion and bridge-like neovascularization,and 4 cases of the right coronary artery woven lesions (thrombotic occlusion and clustered neovascularization).There were 27 cases of the left coronary artery stenosis with different degrees,including 5 cases of the left coronary artery occlusion and bridge-like neovascularization,and 2 cases of the left coronary artery woven lesions (thrombotic occlusion and clustered neovascularization).All of 52 patients with GCAA were followed up for 1 to 19 years.GCAA still existed in 40 cases.Regression to small coronary artery aneurysm was found in 8 cases,and mild-dilation regression was observed only in 4 patients.The resting electrocardiogram showed pathological Q wave and the left ventricular enlargement in 6 cases,and normal in the remaining 46 patients.The children had no subjective symptoms and their activities were not restricted.Compared with SCAG,echocardiography detected 52 cases with proximal morphological changes in the coronary artery,but distal changes were found only in 3 cases.And 12 cases with coronary artery occlusion and neovascularization failed to be prompted by echocardiography.Conclusions GCAA induced by KD can persist for a long time,and has characteristics of coronary occlusion,stenosis,and collateral vessel formation.The conventional electrocardiogram and echocardiography are insensitive to the coronary artery morphology and dysfunction in KD sequelae.The SCAG is of great value in tracking this disease.For using SCAG in children,as long as the appropriate equipment and projection angle are selected,and the operation skills are mastered,satisfactory images and high success rate can be obtained.
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Objective To investigate the safety and efficacy of Warfarin combined with Aspirin in the treatment of multiple medium and giant coronary artery aneurysms in Kawasaki disease(KD).Methods Clinical and followup data of 45 children diagnosed with KD complicated with multiple medium-sized and giant coronary artery aneurysms from April 2014 to December 2018 at Guangzhou Women and Children's Medical Center were collected.These children were divided into 2 groups.A total of 31 cases received regular oral Warfarin combined with Aspirin called experimental group.There were 14 patients treated with oral Aspirin and Clopidogrel called control group.General information,laboratory examination,electrocardiogram,echocardiography,outcome and bleeding complications of the 2 groups were analyzed retrospectively.Results (1) In experimental group,there were 22 patients found thrombosis under echocardiography.The 10 patients' thrombosis disappeared,5 patients' thrombosis reduced,and 2 patients' increased after treatment.In control group,there were 5 cases found thrombosis.The 2 cases' thrombosis reduced and 3 cases' thrombosis increased.The number of thrombosis in experimental group was significantly reduced,and the number of new thrombosis was less than that in control group (x2 =6.454,P ＜ 0.05).(2) The number of coronary artery aneurysms in experimental group increased slowly than that in control group [12.90％ (4/31 cases) vs.14.28％ (2/14 cases)].(3) The number of coronary artery aneurysms in experimental group decreased rapidly than that in control group [23.91％ (11/46 cases)vs.10.00％ (1/10 cases)].(4) The number of cases of tumor retraction in experimental group was more than that in control group [74.19％ (23/31 cases)vs.42.85％ (6/14 cases)].(5) During the followed-up,there was no abnormality in the blood phosphokinase isozyme and troponin,no abnormality in the electrocardiogram and echocardiogram,no ventricular enlargement and abnormal ventricular wall movement,and the ejection fraction value was within the normal range.No active bleeding and no death occurred in the two groups.Conclusions Warfarin combined with Aspirin is very safe and effective in the treatment of KD coronary tumor,it can reduce thrombosis effectively.Compared with oral Aspirin and Clopidogrel,Warfarin combined with Aspirin can reduce the number of multiple medium sized and large coronary artery aneurysms and reduce the diameter of coronary artery aneurysms.
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Objective To analyze the treatment and follow-up of congenital coronary artery fistula (CAF) with giant coronary artery aneurysm (GCAA) in children.Methods The clinical data were analyzed retrospectively in 13 patients who were diagnosed as congenital CAF with GCAA between July 2009 and December 2016 in Guangzhou Women and Children's Medical Center.There were 8 boys and 5 girls.The median age was 18 months,ranging from 40 days to 12 years old.The body weight ranged from 3.8 kg to 29.0 kg with a median of 8.8 kg.Fistulas originated from right coronary artery accounted in 8 patients,with 5 from left coronary artery.Fistulas drained into right atrium in 3 patients,right ventricular in 8 patients and left ventricular in 2 patients.Single fistula occurred in 12 patients and multiple fistulas in 1 patient.The diameter of coronary artery aneurysm ranged from 8 mm to 16 mm with a median of 9.2 mm.Results One patient had tachypnea and growth retardation without heart murmur.The other 12 patients were asymptomatic with heart murmurs occasionally found in routine physical examination.One patient underwent fistula ligation without cardiopulmonary bypass (CPB).The remaining 12 cases received fistula correction with beating heart CPB.Direct suture was used in 10 patients and autologous pericardial patch in other 2 patients.Two patients were associated with atrial septal defect (ASD) and underwent repair of ASD concurrently.The coronary artery aneurysm remained original shape without any intervention during the operation.The mean hospital delay was (11.0 ± 2.5) days.Two patients had decreased ejection fraction as low as 38％ within 3 days after the operation,but went up to over 50％ in follow-up 1 month later.Transient T wave change occurred in 7 patients,and another 2 patients showed a residual shunt with size of 1 to 2 millimeters through the fistula without further intervention after the surgical closure.All 13 patients had antiplatelet therapy with 12 taking Aspirin and one taking Dipyridamole.The dosage was 3-5 mg/(kg · d) with duration ranging from 3 days to 13 months with a median of 1 month.During the perioperative period and the follow-up period (3 months to 8 years),all patients were asymptomatically alive.Transthoracic echocardiography showed normal cardiac function.Compared with preoperative status,the diameter of dilated coronary arteries was not changed after the operation.There was no formation of thrombus in the coronary arteries.Electrocardiography showed no ST-T changes or arrhythmia or myocardial ischemia.Conclusions GCAA can be combined with congenital CAF in children,so it needs early operation.The evidence-based intervention of coronary artery aneurysm and usage of anticoagulant and antiplatelet therapy in pediatric patients was still lacking,which needs long-term follow-up.
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Objective To analyze the angiographic and intravascular ultrasound(IVUS) characteristics of 65 coronary artery aneurismal lesions and to evaluate the effects of interventional and medical therapy. Methods 65 in-hosptal patients with coronary artery aneurysmal lesions with both quantitive coronary angiography and IVUS data from 10/2007 to 10/2014 were retrospectively analyzed in our center. Aneurysmal lesions were confi rmed as ture coronary artery aneurysms(CAA) (n=32)or false aneurysms(n=33)by IVUS. The angiography and IVUS characteristics in both groups were analyzed. Patients with aneurysmal lesion were provided with interventional or medical therapy according to the severety of stenosis. The major adverse cardiac events(MACE) were observed in these patients for two years. Results LAD and RCA were the most common sites of true CAA lesions(40.6% and 34.4% respectively).Compared with the false aneurysm group, the ture aneurysm group had longer aneurysm[(11.1±5.8)mm vs.(5.9±2.7)mm,P<0.001], more bifurcation vessels(21 cases vs. 8 cases,P=0.001),bigger luminal external elastic membrane[(25.6 ±10.7)mm2vs.(17.7±6.6)mm2,P=0.001],bigger luminal diameters [(6.2±1.5)mm vs.(5.3±1.0)mm,P=0.005]and bigger cross sectional area[(33.5±12.0)mm2vs. (25.8±7.9)mm2, P=0.003]. The false aneurysms group had bigger plaque burdens than the ture aneurysms[(32.4±10.7)% vs.(23.0±9.8)%,P=0.001].The ratios of receiving percutaneous coronary intervention(PCI) and medical therapy were the same in the two groups (P=0.272). The percentage receiving crossover stenting was higher in the false aneurysms group(33.3% vs. 6.2%, P=0.006). There were no cardiac death and acute myocardial infarction in both groups.One subacute in-stent thrombosis happened in the ture aneurysm group. Conclusions IVUS is a good method for diff erentiation of CAA from false coronary aneurysm. Most aneurysms were adjacent to severe stenosis and vessel bifurcation. It implied that maybe the changes of flow hemodynamics were related to the formation of coronary artery aneurysm. Sufficient and long term anti-thrombotic therapy and provisional interventions to aneurysmal unilateral severe stenosis may be a good choice of treatment for CAA.
Subject(s)
Humans , Male , Middle Aged , Coronary Aneurysm/etiology , Mucocutaneous Lymph Node Syndrome/complications , Severity of Illness Index , Coronary Aneurysm/surgery , Coronary Aneurysm/diagnosis , Diagnosis, Differential , Asymptomatic Diseases , Mucocutaneous Lymph Node Syndrome/surgery , Mucocutaneous Lymph Node Syndrome/diagnosisABSTRACT
Objective To summarize the echocardiographic findings and clinical characteristics of Kawasaki disease(KD) complicated with coronary artery thrombosis (CAT).Methods Thirty-five patients with KD combined with CAT were enrolled,who were admitted to Beijing Children's Hospital,Capital Medical University between July 2005 and August 2016.The clinical characteristics and echocardiographic findings during follow-ups were retrospectively studied.According to whether the childrenhad been complicated with myocardial ischemia,the patients were divided into 2 groups:ischemic group and non-ischemic group.The duration of fever,the time when the intravenous immunoglobulin(IVIG) was first injected,the time when coronary artery aneurysms (CAA) was formed,the maximum diameter of CAA and inflammatory index inthe acute phase were compared between 2 groups.Results All of the 35 children diagnosed as KD combined with CAT suffered firom CAA,and the coronary thrombosis was detected in all the cases with aneurysms.Thirty-five patients had 99 branches of CAA,of which the maximum diameter of CAA was (9.6 ± 3.1) mm(4.0-19.0 mm).Fifty-four plots of CAT were detected in the aneurysms.The diameter of CAA that thrombosis located was larger than that of which the thrombosis was not located[(10.9 ± 2.8) mm vs.(7.9 ± 2.6) mm],and the difference was significant(P ＜0.01).During 4 months to 10 years and 8 months [(39.2 ±29.5) months] follow-ups,CAA regressed in 32 branches [32.3％ (32/99 branches)],of which 4 branches [4.0％ (4/99 branches)] completely regressed to the normal diameter.The maximum diameter of CAA regressed was smaller than the maximum diameter of CAA consistence [(7.3 ± 1.9) mm vs.(10.6 ± 3.0) mm],and the difference was significant (P ＜ 0.01).Out of 35 patients,15 cases [42.9％ (15/35 cases) had myocardial ischemia,while the other 20 cases[57.2％ (20/35 cases)] didn't have.Among 15 cases with myocardial ischemia,6 cases[17.1％ (6/35 cases)] had myocardial infarction,4 cases [11.4％ (4/35 cases)] had heart failure,and 1 case[2.9％ (1/35 cases)] died of acute heart failure complicated with severe ventricular arrhythmia.Compared with non-ischemic group,the children in the ischemic group had longer duration of fever[(19.1 ± 7.8) d vs.(12.1 ± 3.3) d],higher white blood cell account in the acute phase[(24.8 ± 13.5) × 1012/L vs.(19.7 ±4.0) × 1012/L],later treatment of IVIG [(13.9 ± 5.5) d vs.(9.8 ±3.8) d],and earlier CAA formation [(16.0 ±4.9) d vs.(20.9 ± 14.5) d],and the differences were statistically significant (all P ＜ 0.05).Conclusions CAT of children with KD commonly originates from CAA.Patients who have more serious inflammatory reaction in the acute phase,earlier formation,heavy severity and longer consistence of CAA are prone to have myocardial ischemia.Echocardiographic study plays an important role in monitoring CAA,detecting the CAT and finding the early left ventricle dysfunction,which is of clinical significance.