Subcostal two-dimensional echocardiographic imaging of peripheral right coronary artery in Kawasaki disease.

A new two-dimensional echocardiographic technique was developed to detect peripheral right coronary aneurysms in Kawasaki disease. Because the main stem of the right coronary artery runs along the tricuspid valve ring and the posterior interventricular groove, these regions were examined for coronary aneurysms using the subcostal approach. Of 52 patients with Kawasaki disease, 14 right coronary aneurysms were visualized in eight patients. Most of the coronary aneurysms were elicited as circular or oval echo-free spaces on the right side of the right ventricle or at the area around the tricuspid valve ring. These echocardiographic features coincided well in size, shape and anatomic position with angiographic appearances. The subcostal approach could not image the normal coronary artery. In three patients whose echocardiograms showed no abnormal echo-free space, the angiographic studies proved that the right coronary arteries were intact. These results suggest that this echocardiographic technique is useful for detecting peripheral right coronary aneurysms in patients with Kawasaki disease.