Wang Xiqiang, Qiang Hua, Liu Ping, Bai Ling, Fan Xiaojuan
Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
J Int Med Res. 2020 Jan;48(1):300060519862947. doi: 10.1177/0300060519862947. Epub 2019 Jul 25.
Coronary artery aneurysms, rare lesions of Kawasaki disease (KD) and coronary atherosclerosis, are associated with severe cardiac complications. We herein describe an interesting case of coronary artery aneurysms due to exertional angina with possible underlying KD. A 26-year-old man without traditional risk factors for atherosclerosis presented with exertional chest pain and a positive exercise electrocardiogram stress test. Coronary angiography revealed total obstruction of the right coronary artery at the proximal portion, and the proximal left anterior descending artery contained a large spherical cavity filled with contrast agent; thus, the diagnosis of coronary artery aneurysms was confirmed. This was a typical coronary lesion suggestive of KD, and coronary artery bypass grafting was recommended. The diagnosis of KD may be ignored or missed in childhood, and significant cardiovascular damage may remain silent until adulthood, when severe coronary artery stenosis or thrombosis results in angina or acute myocardial infarction. Thus, to promote timely treatment and reduce morbidity and mortality, antecedent KD should be considered in the presence of angina pectoris or acute myocardial infarction in young patients without traditional risk factors for atherosclerosis.
冠状动脉瘤是川崎病（KD）和冠状动脉粥样硬化的罕见病变，与严重的心脏并发症相关。我们在此描述一例因劳力性心绞痛伴可能潜在的KD导致冠状动脉瘤的有趣病例。一名无传统动脉粥样硬化危险因素的26岁男性出现劳力性胸痛，运动心电图负荷试验阳性。冠状动脉造影显示右冠状动脉近端完全闭塞，左前降支近端有一个充满造影剂的大球形腔；因此，冠状动脉瘤的诊断得以证实。这是一个提示KD的典型冠状动脉病变，建议进行冠状动脉搭桥术。KD的诊断在儿童期可能被忽视或漏诊，显著的心血管损害可能一直无症状直至成年期，此时严重的冠状动脉狭窄或血栓形成会导致心绞痛或急性心肌梗死。因此，为促进及时治疗并降低发病率和死亡率，对于无传统动脉粥样硬化危险因素的年轻患者出现心绞痛或急性心肌梗死时，应考虑既往KD病史。
