No abstract

No abstract

The cross-sectional echocardiographic technique for detecting coronary artery aneurysms of mucocutaneous lymph node syndrome (MLNS) was examined. When cutting the aortic root in round slices by the echocardiographic scanner, each of the right and left coronary arteries was imaged as a linear echo-free structure arising from the aortic root. Of 22 normal subjects, the left main coronary artery was imaged in all, the anterior descending branch in 18, the circumflex branch in six, and the right coronary artery in 18. Of 41 patients with MLNS, coronary artery aneurysms were detected as large echo-free spaces in four patients who were proved later to have these lesions by coronary angiography or autopsy. In addition, in four patients, whose echocardiograms demonstrated the coronary arteries to be normal, the angiographic studies showed that the coronary arteries were intact. These results suggest that the cross-sectional echocardiographic technique is a useful noninvasive diagnostic method for imaging the coronary arteries and the aneurysms in MLNS.

SUMMARY 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.CORONARY ANEURYSM is an ominous complication of Kawasaki disease that carries a risk of sudden death."' Two-dimensional echocardiography can be used to visualize coronary aneurysms using the parasternal approach.'0 '3 However, this approach visualizes only limited areas of the proximal segments of the coronary arteries. In this study we describe a technique for detecting peripheral coronary aneurysms in the main stem of the right coronary artery (RCA) from the ostium to the posterior descending artery using the subcostal approach. Subjects and MethodsTwo-dimensional echocardiograms were recorded in 52 patients with Kawasaki disease (31 males and 21 females), ages 2 months to 8 years, whose conditions were assessed on the basis of the guidelines prepared by the Japanese Research Committee in 1978. Coronary angiography was performed in eight patients who were suspected of having coronary aneurysms by echocardiographic studies and in three other patients suspected of having the lesions by the clinical picture and laboratory data.We performed this study using a real-time mechanical sector instrument (Aloka SSD 1000 with ASU 25 hand scanner and USM 6B amplifier). The scanner probe, which contained a 3-MHz transducer focused at 7.5 cm, was mechanically driven through a variable angle (30-80°) at a rate of 30 frames/sec, which yielded a line density of approximately 110 lines/frame. Two-dimensional echocardiographic images were observed in real time during the examinations. These images. which were displayed at phaseselected single frames, were photographed directly from the oscilloscope screen with a Polaroid camera, and the real-time images were recorded by a 16-mm The subcostal approach that we developed for imaging peripheral coronary aneurysms in the main stem of RCA is composed of two parts. The first part is an approach for detecting coronary aneurysms in segment 1, segment 2 and the proximal half of segment 3 (segmental...

No abstract