Tsuda E, Hanatani A, Kurosaki K, Naito H, Echigo S
Department of Pediatrics, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita-shi, Osaka, 565-8565, Japan.
Pediatr Cardiol. 2006 May-Jun;27(3):372-5. doi: 10.1007/s00246-005-1233-8.
We report two young adult patients who had acute coronary syndrome after regression of coronary aneurysms caused by Kawasaki disease (KD). A 26 year-old man had acute anterior myocardial infarction at midnight after drinking alcohol. He had had bilateral coronary aneurysms caused by KD at the age of 8 months. Selective coronary angiograms (CAGs) at the age of 7 years revealed regression of both coronary aneurysms. He had no symptoms until the onset of acute myocardial infarction. The other patient was a 24 year-old man diagnosed as having a subendocardial infarction. He had had bilateral coronary aneurysms caused by KD at the age of 1 year. CAGs at the age of 9 years showed that both had regressed. It should be recognized that young adults with apparently normal coronary arteries angiographically after regression of large coronary aneurysms caused by KD may occasionally have acute coronary syndromes. We suspect intimal involvement of the coronary arterial wall after regression of the large aneurysms underlies the acute coronary syndrome in adults. Risk factors for atherosclerosis must be avoided in this population.
我们报告了两名年轻成年患者，他们在川崎病（KD）所致冠状动脉瘤消退后发生了急性冠状动脉综合征。一名26岁男性在饮酒后午夜发生急性前壁心肌梗死。他在8个月大时曾患双侧冠状动脉瘤。7岁时的选择性冠状动脉造影（CAG）显示双侧冠状动脉瘤均已消退。在急性心肌梗死发作前他没有症状。另一名患者是一名24岁男性，被诊断为心内膜下梗死。他在1岁时曾患双侧冠状动脉瘤。9岁时的CAG显示两者均已消退。应该认识到，KD所致大冠状动脉瘤消退后冠状动脉造影显示明显正常的年轻成年人偶尔可能会发生急性冠状动脉综合征。我们怀疑大动脉瘤消退后冠状动脉壁的内膜受累是成人急性冠状动脉综合征的基础。该人群必须避免动脉粥样硬化的危险因素。
