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  • Title: [Application of selective coronary angiography in children with Kawasaki disease complicated with severe coronary artery lesion].
    Author: He L, Liu F, Huang GY, Wu L, Chu C, Lu Y.
    Journal: Zhonghua Er Ke Za Zhi; 2019 Feb 02; 57(2):108-112. PubMed ID: 30695884.
    Abstract:
    Objective: To investigate the application of coronary angiography (CAG) in children with Kawasaki disease complicated with coronary artery lesion (CAL). Methods: A total of 139 patients (115 boys and 24 girls, age (48±42) months) with Kawasaki disease complicated with CAL underwent CAG between June 2006 and June 2018 in Children's Hospital of Fudan University. CAL in all children were at grade Ⅲ and above assessed by echocardiography and underwent CAG under general anesthesia with parental consent. A retrospective analysis was performed to identify the safety and complication of CAG, degree of satisfaction of image, distribution of CAL, and the treatment and follow-up management according to the result of CAG. Results: All the 139 patients underwent CAG, and 17 patients received CAG twice. In these cases, there was a total of 309 CAL with an average of 2.22 CAL per patient. After CAG, children were re-graded as grade Ⅲ in 33 cases, grade Ⅳ in 56 cases, grade Ⅴa in 33 cases and grade Ⅴb in 17 cases according to the clinical severity. Ten patients (7.2%) had only aortic root angiography and 129 (92.8%) patients had selective left or right CAG. Among these, 27 cases (19.4%) showed thrombosis in coronary aneurysm, 23 cases (16.5%) showed coronary artery stenosis, 4 cases (2.9%) showed recanalization after occlusion in right coronary artery. All the patients obtained satisfied images, and no complication was found. Eight of the grade Ⅴb patients underwent coronary artery bypass grafting (CABG). One patient died during the surgery due to severe heart failure, and the other seven patients received CABG successfully and recovered well during a long-term follow up (18 to 108 months). Conclusions: CAG is safe for children with Kawasaki disease with CAL, and the images of CAG are satisfied. Patients who were graded according to CAG and received the corresponding surgical treatment could get satisfied effect in the medium and long-term follow-up. 目的： 分析冠状动脉造影（CAG）在儿童川崎病合并冠状动脉病变（CAL）中的应用。 方法： 回顾性分析2006年6月至2018年6月在复旦大学附属儿科医院住院的139例川崎病合并CAL患儿的临床资料，男115例，女24例，年龄（48±42）月龄，经超声心动图检查评估为CAL临床严重程度分级Ⅲ级及以上，经家长签署同意书后在全身麻醉下进行CAG检查，分析CAG的安全性、图像获取的满意度及并发症、CAL的分布情况，根据CAG检查结果给予不同治疗及随访方案。 结果： 共139例川崎病患儿行CAG，其中17例患儿行重复造影。共有309支冠状动脉发生病变，平均每例患儿有2.22支冠状动脉发生病变。CAG后139例患儿的临床严重程度分级分别为：Ⅲ级33例，Ⅳ级56例，Ⅴa级33例，Ⅴb级17例。其中10例（7.2%）患儿仅做主动脉根部造影，其余129例（92.8%）患儿行选择性左右CAG。27例（19.4%）患儿冠状动脉瘤内有血栓形成；23例（16.5%）患儿有冠状动脉狭窄；4例（2.9%）患儿右冠状动脉阻塞后再通。所有患儿均获得满意图像，无并发症发生。Ⅴb级患儿中8例行冠状动脉搭桥手术，1例患儿由于严重心力衰竭手术中死亡，其余7例手术顺利，术后随访18~108个月恢复良好。 结论： 在川崎病CAL患儿中进行CAG安全，可获取满意图像；根据CAG进行CAL临床严重程度分级并给予相应手术治疗方案，中长期随访可获得满意效果。.
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