Kinoshita Y, Suzuki A, Nakajima T, Ono Y, Arakaki Y, Kamiya T
Department of Pediatrics, Hiroshima Prefectural Hiroshima Hospital, Japan.
Heart Vessels. 1996;11(4):203-10. doi: 10.1007/BF02559993.
Using myocardial contrast echocardiography (MCE), coronary arteriography, and thallium-201 myocardial imaging (TMI), we examined the characteristics and the role of collateral vessels in 35 patients with coronary artery lesions after Kawasaki disease. The male/female ratio was 25:10. The patients' ages are examination ranged from 1.0 to 20.3 years (mean, 10.8 years). The age at onset of Kawasaki disease ranged from 0.3 to 11.6 years (mean, 2.6 years). The coronary artery lesions were: dilated lesions without coexistent stenotic lesions in 5 patients (14%), localized stenosis with less than 50% narrowing in 5 patients (14%), localized stenosis with 50% or more narrowing in 4 patients (11%), and obstructive lesions, such as occlusion and/or segmental stenosis, in 21 patients (60%). In the group with no stenotic lesions and the group with less than 50% localized stenosis, the perfusion area of the right coronary artery was 32.6 +/- 8.4% and that of the left coronary artery was 76.3 +/- 7.9%. The total perfusion area of the right and the left coronary arteries was 108.9 +/- 2.6%, which value was inversely correlated with age at examination (r = 0.716, P = 0.020). In the group more than 50% localized stenosis, an increase in overlap areas detected by MCE, where a perfusion defect was seen on TMI, was not found, except in 1 patient with 99% stenosis. In the patients with obstructive lesions development of collateral channels was better in the perfusion area of the occluded right coronary artery than in that of the occluded left coronary artery, and well developed collateral channels were significantly correlated with good wall motion. We conclude that overlapping perfusion occurs in younger rather than in older children without stenotic coronary systems, and this may contribute to the food development of collateral circulation in infants and young children with coronary artery lesions after Kawasaki disease.
我们使用心肌对比超声心动图（MCE）、冠状动脉造影和铊-201心肌显像（TMI），对35例川崎病后冠状动脉病变患者的侧支血管特征及作用进行了研究。男女比例为25:10。接受检查患者的年龄范围为1.0至20.3岁（平均10.8岁）。川崎病发病年龄范围为0.3至11.6岁（平均2.6岁）。冠状动脉病变情况如下：5例患者（14%）为无并存狭窄病变的扩张性病变；5例患者（14%）为局限性狭窄，狭窄程度小于50%；4例患者（11%）为局限性狭窄，狭窄程度为50%或更高；21例患者（60%）为阻塞性病变，如闭塞和/或节段性狭窄。在无狭窄病变组和局限性狭窄小于组50%中，右冠状动脉灌注面积为32.6±8.4%，左冠状动脉灌注面积为76.3±7.9%。左右冠状动脉总灌注面积为108.9±2.6%，该值与检查时年龄呈负相关（r = 0.716，P = 0.020）。在局限性狭窄超过50%的组中，除1例狭窄程度为99%的患者外，未发现MCE检测到的重叠区域增加，而TMI显示该区域存在灌注缺损。在阻塞性病变患者中，闭塞右冠状动脉灌注区域的侧支通道发育优于闭塞左冠状动脉灌注区域，且发育良好的侧支通道与良好的室壁运动显著相关。我们得出结论，在无狭窄冠状动脉系统的儿童中，重叠灌注在年龄较小而非较大的儿童中出现，这可能有助于川崎病后冠状动脉病变婴幼儿侧支循环的良好发育。
