He L, Liu F, Huang G Y, Wu L, Chu C, Lu Y
Heart Center of Children's Hospital of Fudan University, Shanghai 201122, China.
Zhonghua Er Ke Za Zhi. 2019 Feb 2;57(2):108-112. doi: 10.3760/cma.j.issn.0578-1310.2019.02.009.
To investigate the application of coronary angiography (CAG) in children with Kawasaki disease complicated with coronary artery lesion (CAL). 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. 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). 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.
探讨冠状动脉造影（CAG）在川崎病合并冠状动脉病变（CAL）患儿中的应用。2006年6月至2018年6月期间，复旦大学附属儿科医院对139例川崎病合并CAL患儿（115例男孩，24例女孩，年龄（48±42）个月）进行了CAG检查。所有患儿的CAL经超声心动图评估均为Ⅲ级及以上，并在获得家长同意后于全身麻醉下进行CAG检查。进行回顾性分析，以确定CAG的安全性和并发症、图像满意度、CAL分布情况以及根据CAG结果进行的治疗和随访管理。139例患儿均接受了CAG检查，17例患儿接受了两次CAG检查。这些病例中共有309处CAL，平均每名患儿2.22处。CAG检查后，根据临床严重程度，患儿重新分级为Ⅲ级33例、Ⅳ级56例、Ⅴa级33例、Ⅴb级17例。10例患儿（7.2%）仅行主动脉根部造影，129例患儿（92.8%）行选择性左或右冠状动脉造影。其中，27例（19.4%）冠状动脉瘤内有血栓形成，23例（16.5%）有冠状动脉狭窄，4例（2.9%）右冠状动脉闭塞后再通。所有患儿均获得满意图像，未发现并发症。Ⅴb级患儿中有8例行冠状动脉旁路移植术（CABG）。1例患儿术中因严重心力衰竭死亡，另外7例患儿CABG手术成功，长期随访（18至108个月）恢复良好。CAG检查对川崎病合并CAL患儿是安全的，且CAG图像满意。根据CAG分级并接受相应手术治疗的患儿在中长期随访中可获得满意效果。
