The vascular function of the long-term coronary artery after Kawasaki disease--evaluation by intracoronary injection of acetylcholine.

The vascular function of the coronary arteries in children after Kawasaki disease (KD) as yet remains uncertain. Here we report our findings of the vascular response of the coronary arteries after intracoronary injection of acetylcholine in patients after KD. A total of 29 patients, 19 after KD and 10 as control, were examined using coronary angiography (CAG). These were divided into 4 groups according to the type of the coronary artery lesions: Group 1 consisted of those with regressed aneurysms and involved 29 sites. These aneurysms had developed in the acute stage and had subsequently regressed and demonstrated normal findings in follow-up CAG. Group 2 consisted of those with persistent aneurysms involved 30 sites. Group 3 involved 52 angiographically normal sites in patients after KD. And Group 4 consisted of control patients and involved 70 sites. These patients had congenital heart disease with normal coronary arteries. During CAG we infused 15 micrograms acetylcholine chloride into the right or left coronary artery. The luminal diameters were measured using a cine-videodensitometric analyser to study the distensibility of the coronary artery wall. The change in the diameter was an increase of 13.71% +/- 15.09% (mean +/- SD) in the normal KD Group 3, and 12.21% +/- 13.83% in the control Group 4, demonstrating marked vasodilatation. In contrast, the change in the regressed aneurysms Group 1, and in the persistent aneurysms Group 2, was -2.65% +/- 16.65%, and -0.08% +/- 6.51%, respectively, demonstrating no change or mild vasoconstriction. The change in Group 1, and in Group 2, was less than in normal Group 3 or control Group 4. The normal Group 3 showed no significant difference from control Group 4. These findings suggested that the coronary artery with regressed aneurysms, or with persistent aneurysms after KD has impaired vascular function and is therefore at risk for developing to atherosclerosis in the long-term.