Hijazi Z M, Udelson J E, Snapper H, Rhodes J, Marx G R, Schwartz S L, Fulton D R
Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts.
J Am Coll Cardiol. 1994 Dec;24(7):1633-8. doi: 10.1016/0735-1097(94)90167-8.
The aim of this study was to determine whether persistent coronary aneurysms in patients with Kawasaki disease are associated with altered myocardial perfusion and function.
Some patients with Kawasaki disease have died suddenly because of severe coronary artery stenosis; others have chronic coronary aneurysms.
Eleven patients with chronic coronary aneurysms were enrolled in the study. The size of the aneurysms and the degree of associated stenosis were determined by angiography in nine patients and by echocardiography in two. All patients underwent simultaneous function and myocardial perfusion assessment during symptom-limited exercise by echocardiography and technetium-99m sestamibi imaging, respectively.
Of 33 vascular territories, 18 contained coronary aneurysms measuring 3.5 to 10 mm. Three aneurysms were associated with significant stenosis as detected by angiography. Of the 18 vascular territories, 13 were normal, and 5 manifested stress-induced perfusion defects; of the latter 5 areas, 4 had associated wall motion abnormalities. The three territories supplied by stenotic coronary arteries had both abnormal regional function and perfusion demonstrated during exercise.
Patients with chronic coronary aneurysms may have associated stenosis, as detected by angiography, with a subjacent myocardium that is subject to abnormal perfusion and function. However, the majority of coronary aneurysms are associated with normal regional coronary flow reserve, as assessed by myocardial perfusion imaging, and even giant coronary aneurysms may be associated with normal coronary flow reserve and preserved regional myocardial function during stress.
本研究旨在确定川崎病患者持续性冠状动脉瘤是否与心肌灌注和功能改变相关。
一些川崎病患者因严重冠状动脉狭窄而突然死亡；另一些患者则患有慢性冠状动脉瘤。
11例慢性冠状动脉瘤患者纳入本研究。9例患者通过血管造影、2例患者通过超声心动图确定动脉瘤大小及相关狭窄程度。所有患者在症状限制运动期间，分别通过超声心动图和锝-99m 甲氧基异丁基异腈显像同时进行功能和心肌灌注评估。
在33个血管区域中，18个区域存在3.5至10毫米的冠状动脉瘤。血管造影检测到3个动脉瘤伴有明显狭窄。18个血管区域中，13个正常，5个表现为应激诱导的灌注缺损；在这5个区域中，4个伴有室壁运动异常。运动期间，狭窄冠状动脉供血的3个区域表现出局部功能和灌注异常。
血管造影检测显示，慢性冠状动脉瘤患者可能伴有狭窄，其下方心肌存在灌注和功能异常。然而，通过心肌灌注显像评估，大多数冠状动脉瘤与局部冠状动脉血流储备正常相关，即使巨大冠状动脉瘤在应激期间也可能与冠状动脉血流储备正常及局部心肌功能保留相关。
