Tatara K, Kusakawa S, Itoh K, Kazuma N, Lee K, Hashimoto K, Shinohara T, Kondoh C, Hiroe M
Department of Pediatrics, Tokyo Women's Medical College Daini Hospital, Japan.
Heart Vessels. 1989;5(1):47-51. doi: 10.1007/BF02058358.
The prognosis of coronary artery obstruction was studied in patients with Kawasaki disease. Between May 1973 and December 1987, coronary artery obstruction was diagnosed by coronary angiography in 30 patients (21 males, 9 females), of whom, only 8 (26.7%) had clinical symptoms. One patient died after 9 years of illness. Two complained of frequent chest pain, which disappeared after bypass surgery in one case and spontaneously in the other. Five had symptomatic myocardial infarction. Myocardial ischemia was diagnosed in 31.8% by treadmill stress testing, but was well demonstrated in 85.7% by thallium-201 myocardial tomography. Frequent ventricular premature beats, Wenckebach-type atrioventricular block, and ST-segment depression accompanied by chest pain were recognized by 24-h Holter monitoring. In the past, the methods used to determine the prognosis of Kawasaki disease patients with coronary artery obstruction were not adequate. However, the examinations used in this study revealed an improved ability to determine the prognosis in this disease. Myocardial tomography, in particular, provided a more accurate evaluation of myocardial damage. Ventricular arrhythmias seem to be a serious problem in these patients. Therefore, careful observation using these tests, especially myocardial tomography and Holter monitoring, should be done even if the patients are free of symptoms.
对川崎病患者的冠状动脉阻塞预后进行了研究。在1973年5月至1987年12月期间，通过冠状动脉造影诊断出30例冠状动脉阻塞患者（男21例，女9例），其中只有8例（26.7%）有临床症状。1例患者在患病9年后死亡。2例主诉频繁胸痛，1例在搭桥手术后胸痛消失，另1例胸痛自行消失。5例发生有症状性心肌梗死。通过平板运动试验诊断出31.8%的患者有心肌缺血，但通过铊-201心肌断层扫描显示85.7%的患者有心肌缺血。通过24小时动态心电图监测发现频繁室性早搏、文氏型房室传导阻滞以及伴有胸痛的ST段压低。过去，用于确定川崎病合并冠状动脉阻塞患者预后的方法并不充分。然而，本研究中使用的检查显示出在确定该疾病预后方面有了改进的能力。特别是心肌断层扫描，对心肌损伤提供了更准确的评估。室性心律失常在这些患者中似乎是一个严重问题。因此，即使患者无症状，也应使用这些检查，尤其是心肌断层扫描和动态心电图监测进行仔细观察。
