Liu Chunping, Li Junxia, Cui Zhenshuang, Niu Lili, Cui Junyu, Tian Xinli, Shi Yujie
Department of Cardiovascular Disease, General Hospital of PLA Army, Beijing 100700, China.
J Thorac Dis. 2018 Feb;10(2):E108-E112. doi: 10.21037/jtd.2018.01.13.
Early intravenous immunoglobulin (IVIG) is the standard treatment for Kawasaki disease (KD) to reduce the incidence of coronary aneurysms. Patients with atypical presentation or who live in a rural area are less likely to receive treatment in the early stage of presentation and are more likely to develop severe complications. There is little consensus on how to treat coronary aneurysms effectively in the acute or subacute stage especially when giant aneurysms develop that compromise cardiac function. This case study is of a 19-month-old girl who initially was not treated as KD and developed multivessel giant coronary artery aneurysms (CAAs) (>8 mm), acute myocardial infarction, and complete heart block despite late intravenous IVIG administration. Multiple attempts of percutaneous coronary intervention (PCI) failed to open the occlusion in the right artery; therefore, bradycardia persisted. The girl received a permanent pace-maker and was doing well at 12-month follow up.
早期静脉注射免疫球蛋白（IVIG）是川崎病（KD）的标准治疗方法，可降低冠状动脉瘤的发生率。临床表现不典型或居住在农村地区的患者在发病早期接受治疗的可能性较小，发生严重并发症的可能性更大。对于如何在急性期或亚急性期有效治疗冠状动脉瘤，尤其是当出现影响心脏功能的巨大动脉瘤时，几乎没有共识。本病例研究的对象是一名19个月大的女孩，她最初未被当作川崎病进行治疗，尽管后期进行了静脉注射IVIG治疗，但仍发展为多支巨大冠状动脉瘤（>8mm）、急性心肌梗死和完全性心脏传导阻滞。多次经皮冠状动脉介入治疗（PCI）未能开通右动脉的闭塞；因此，心动过缓持续存在。该女孩接受了永久性起搏器植入，在12个月的随访中情况良好。
