Subcostal 2-dimensional echocardiographic imaging of peripheral left coronary artery aneurysms in Kawasaki disease

Maeda, Toshiki; Yoshida, Hitoshi; Funabashi, Takashi; Nakaya, Shigekazu; Takabatake, Shoji; Ohno, Takashi; Taniguchi, Noboru

doi:10.1016/0002-9149(83)90067-x

Cited by 14 publications

(1 citation statement)

References 16 publications

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“…' Cross sectional echocardiography, a noninvasive technique, has recently been used to detect coronary artery aneurysms in patients with Kawasaki disease. 4 We have used this technique as well as clinical criteria including electrocardiography and chest radiographs to determine non-invasively the extent of cardiac involvement and its subsequent course in a group of 18 children with Kawasaki disease.…”

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confidence: 99%

Cardiovascular abnormalities in Kawasaki disease.

Novelli¹,

Galbraith²,

Robinson³

et al. 1984

Archives of Disease in Childhood

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SUMMARY Eighteen patients with Kawasaki disease underwent serial, cross sectional echocardiographic examinations to determine the extent and subsequent course of cardiac involvement in this disease. The mean follow up period was 12-3 months. Cardiovascular complications were found in a total of 10 patients (55%). Coronary artery aneurysms were detected in 6 patients (33%), pericardial effusions in two, and one patient had electrocardiographic evidence suggesting inferior myocardial infarction. Coronary artery aneurysms, seen exclusively in infants less than 12 months of age, were found in four to regress over a mean period of 7-5 months (range 1 to 13 months). Electrocardiogram, chest radiographs, and clinical examination were unhelpful in identifying those patients with coronary artery aneurysms. Eight patients (44%) were hypertensive, though only two required treatment.

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confidence: 99%

Cardiovascular abnormalities in Kawasaki disease.

Novelli¹,

Galbraith²,

Robinson³

et al. 1984

Archives of Disease in Childhood

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Anatomy, histology, and pathology of coronary arteries: A review relevant to new interventional and imaging techniques‐part iv

Orr

Slack

Pinkerton

et al. 1992

Clinical Cardiology

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Summary:In the last 15 years, intense interest has focused on various interventional pharmacologic and mechanical forms of therapy for the treatment of atherosclerosis coronary artery disease. Many techniques and devices (dilating balloons, perfusion catheters, thermal probes and balloons, lasers, atherectomy devices, stents, intravascular ultrasound) have been used or are under study for future use. Many of these techniques and devices require an understanding of histologic and pathologic features of the coronary arteries and diseases which affect them. This article reviews selective areas of anatomy, histology, and pathology relevant to the use of various new interventional techniques. Part IV of this review will focus on congenital coronary artery anomalies, myocardial bridges, coronary aneurysm, emboli, and dissection and clinical implications regarding echocardiographic imaging techniques.Key words: coronary artery, congenital anomalies, tunneled artery, coronary aneurysm, coronary dissection, coronary embolus Congenital Coronary Artery AnomaliesNormally the left coronary artery arises from the left aortic sinus of Valsalva and the right coronary artery from the right aortic sinus. Either or both of the right and left coronary arteries may arise from another aortic sinus, from the pulmonary trunk, or as an anomalous branch of another coronary artery (Fig. 1). These variations from normal are referred to as congenital coronary artery anomalies. Congenital coronary artery anomalies are unusual to rare events, depending on the type of coronary anomaly. Because both the right and left coronary arteries can be identified reliably with two-dimensional echocardiography (2-D echo), anomalous origin of the left or right coronary artery from another sinus of Valsalva, origin of one or both arteries from the pulmonary trunk, andor origin of the entire coronary tree from a single coronary artery are potentially recognizable by the use of 2-D echo'" (Figs. 3-9). Finding a coronary ostium in an unexpected sinus location, finding an abnormal number of coronary ostia, or detecting an abnormally large (dilated) coronary artery can provide echocardiographic clues to the diagnosis of an anomalous coronary vessel. Anomalous origin of a major coronary artery as a branch of another major coronary artery is less likely to be recognized echocardiographically. Although visualization of a single coronary ostium raises the possibility of a single congenital coronary artery, alternate possibilities include acquired total occlusion of the other major coronary artery by atherosclerotic plaque, thrombus, both, or anomalous origin of the missing coronary artery as a branch of another coronary artery.

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Echocardiographic features of a giant congenital aneurysm of the right coronary artery

Zhang¹,

Hu²,

Hsieh³

et al. 1988

J of Clinical Ultrasound

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Coronary artery aneurysms are uncommon, but since the introduction of coronary angiography and more recently echocardiography, several cases have been reported in the In this report we describe the echocardiographic features of an unruptured giant aneurysm of the right coronary artery, which was proved and successfully excised at operation. REPORT ON PATIENTA 25-year-old woman had been well until three months before admission when she experienced palpitation, cough, shortness of breath, and at times dizziness. Peripheral edema was intermittently present. An echocardiographic study suggested a right ventricular mass. On physical examination, the patient appeared ill with purplish-red cheeks, slight icterus sclera, and mild engorgement of the jugular veins. Her blood pressure was 110/90 mmHg and her heart rate was regular at 105 beatdmin. On auscultation, S1 and S2 were normal, and a S4 was heard over the precardium. A grade II/VI systolic ejection murmur was present along the left sternal border. Mild cyanosis at the tip of the fingers without clubbing was noted. The liver was enlarged and there was mild edema of the lower extremities. The chest X-ray showed a slighly enlarged heart shadow with a cardiothoracic ratio of 0.55 and a slightly decreased pulmonary vascularity. The electrocardiogram showed sinus tachycardia, low QRS voltage, and a Q wave in V3-V6 in- 502dicating an old anteroseptal myocardial infarction. Parasternal long-axis two-dimensional echocardiography showed a large oval cystic mass measuring 8 x 12 cm. Cloud-like echoes moved turbulently in the cystic cavity while the cystic mass itself showed little motion. The left atrium and ventricle were very small. The motion of the mitral and aortic valves was difficult to visualize (Figure 1). In the apical four-chamber view, the right ventricle was very small and the cystic tumor was in front of it. In this view, the moving cloud-like echoes were also seen in the cystic cavity. The right atrium was markedly enlarged (Figure 2). At operation, a mass lesion suggestive of a coronary aneurysm was found in front of the right ventricle, almost obscuring the whole operative field. The inferior and superior vena cavae were engorged. The right atrium measured approximately 12 cm in diameter and the giant oval cystic lesion measured 13 cm X 15 cm. No blood vessels were found on its surface. Temporal occlusion of both the proximal and distal openings caused no EKG changes, which suggested there were adequate collaterals.Cardiopulmonary bypass was instituted and the cystic tumor decreased in size. It was founc! to be an aneurysm of the right coronary artery containing oxygenated blood arising from the proximal segment of the right coronary artery about 3 cm from its origin. The aneurysm measured 15 cm in diameter and its wall was about 4 mm in thickness. The aneurysmal wall was smooth and no mural thrombus was found. The proximal and distal openings of the aneurysm were about 0.5 cm and 0.2 cm in diameter, respectively. The aneurysm of the right coronary artery wa...

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Subcostal 2-dimensional echocardiographic imaging of peripheral left coronary artery aneurysms in Kawasaki disease

Cited by 14 publications

References 16 publications

Cardiovascular abnormalities in Kawasaki disease.

Cardiovascular abnormalities in Kawasaki disease.

Anatomy, histology, and pathology of coronary arteries: A review relevant to new interventional and imaging techniques‐part iv

Echocardiographic features of a giant congenital aneurysm of the right coronary artery

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