Suzuki A, Kamiya T, Arakaki Y, Sato I, Tsuchiya K, Kohata T
Department of Pediatrics, National Cardiovascular Center, Suita.
J Cardiol. 1987 Sep;17(3):521-30.
To study valvular lesions in the acute phase of Kawasaki disease, 17 patients who were admitted to our institution before the 12th day of their illness were examined using real-time two-dimensional Doppler flow imaging (2DD: Toshiba SSH 65A) from January to September 1986. Pulsed Doppler, continuous wave Doppler, and M-mode echocardiography were also performed. Patients were examined daily from their admission to 12th day of illness, and after that, more than twice a week until the 28th day of illness. Fourteen of the 17 patients underwent Ga-67 scintigraphy. Cardiac catheterization, including selective coronary arteriography, was performed in 15 patients in the convalescent phase. Mitral regurgitation (MR) was detected in eight of the 17 cases (47%). MR appeared on 2DD 7.5 +/- 1.6th day of illness (mean +/- SD), lasting until 11.9 +/- 5.7th day of illness. MR was transient and mild in degree in all cases, and the regurgitant jet was directed towards the left atrial posterior wall. Neither prolapse nor deformity of the mitral valve was detected. The left ventricular volume indices (determined by the Pombo method) measured by M-mode echocardiography in the acute and convalescent phases were compared. In the group with MR in the acute phase, the end-diastolic volume index was 66.9 +/- 19.9 ml/m2 and the end-systolic volume index was 21.0 +/- 11.7 ml/m2. These were significantly greater than those in the convalescent phase (51.3 +/- 13.1 ml/m2, 14.1 +/- 4.0 ml/m2, respectively). However, no significant differences were observed in the group without MR. Positive uptake of Ga-67 was observed in six patients with MR, but in none of the seven without MR. The incidence of positive uptake was significantly higher in the patients with MR. Cardiac catheterization performed in the convalescent phase revealed that no patient had the findings of MR, other valvular lesions, coronary arterial lesions, or abnormal ventricular performance.
为研究川崎病急性期的瓣膜病变，1986年1月至9月期间，对17例在发病第12天之前入院的患者使用实时二维多普勒血流成像（2DD：东芝SSH 65A）进行检查。同时还进行了脉冲多普勒、连续波多普勒和M型超声心动图检查。患者从入院至发病第12天每天接受检查，之后至发病第28天每周检查两次以上。17例患者中有14例接受了Ga - 67闪烁扫描。15例患者在恢复期进行了包括选择性冠状动脉造影在内的心脏导管检查。17例患者中有8例（47%）检测到二尖瓣反流（MR）。MR在发病第7.5±1.6天（平均±标准差）出现在2DD上，持续至发病第11.9±5.7天。所有病例中MR均为短暂且程度较轻，反流束指向左心房后壁。未检测到二尖瓣脱垂或畸形。比较了急性期和恢复期通过M型超声心动图测量的左心室容积指数（采用庞博方法测定）。急性期有MR的组中，舒张末期容积指数为66.9±19.9 ml/m²，收缩末期容积指数为21.0±11.7 ml/m²。这些数值显著高于恢复期（分别为51.3±13.1 ml/m²和14.1±4.0 ml/m²）。然而，无MR的组未观察到显著差异。6例有MR的患者观察到Ga - 67阳性摄取，但7例无MR的患者均未观察到。有MR的患者中阳性摄取的发生率显著更高。恢复期进行的心脏导管检查显示，没有患者有MR、其他瓣膜病变、冠状动脉病变或心室功能异常的表现。
