Echocardiographic Visualization of Coronary Arterial Lesions in Kawasaki Disease

川崎症之冠狀動脈病變的超音波顯像

吳美環(Mei-Hwan Wu) ； 呂鴻基(Hung-Chi Lue) ； 鄭素珠(Su-Ju Cheng) ； 宋增銓(Tseng-Chen Sung)

《Acta Paediatrica Sinica》 27卷1期 (1986/02) Pp. 1-9

摘要

冠狀動脈病變為川崎症的主要嚴重併發症，在病發後早期以雙向心臟超音波檢查來篩檢此症患者的冠狀動脈，為一不具侵襲性，準確性高且可重覆施行的有效方法。臺大醫院小兒科自民國72年12月至73年9月，共經歷42例川崎症患者。這些病兒於發病後3至4星期時接受雙向心臟超音波檢查，其中的25例並接受心導管檢查及大動脈根部攝影。另由30例具正常冠狀動脈的先天心臟病兒導出見童各年齡層的參考值。由此，我們定義冠狀動脈的擴大，在2歲以下者為直徑超過2mm；在2歲以上者為直徑超過2.5mm以上。而依其擴大的程度；在超音波及心導管攝影的結果，再分為第一級（紡錠狀擴大或邊緣不規則），第二級（瘤狀擴大者）及第三級（瘤狀擴大合併狹窄者）。在42例病兒中有16例經超音波檢查發現有冠狀動脈病變，均經心導管攝影證實，但有2例微小異常者未能以超音波檢出，而1例正常冠狀動脈誤為輕微擴大。由超音波檢查及心導管攝影所得嚴重度的結果來比較，第三紅的嚴重度不易以超音波檢出。此一限制在考慮病兒是否有必要接受心臟手術以免突發心臟梗塞危險時，可能有影響。另以，以多切面來檢查左右冠狀動脈遠端分支病變，及改用較佳解像力的超音波探頭，均可再提高超音波檢查的準確度。

並列摘要

An increase in the incidence of Kawasaki disease in Taiwan in 1982 prompted the use of two-dimensional echocardiography (2.D echo) in screening Kawasaki patients for early detection of coronary lesions and also in followed u examinations. From July 1982 to September 1984, a total of 42 patients (31 boys and 11 girls) of Kawasaki disease were examined with 2-D echo: twenty-five of them received, also aortic root angiography (angio) during the initial 3-4 weeks of the disease.
Another 30 patients with congenital heart disease whose coronary arteries appeared normal served as controls. Their coronary arteries, visualized by angio, were measured. Based on that data, coronary arterial dilatation was defined as a diameter over 2mm in those below 2 years of age, and over 2.5mm in those over 2 years of age.
The 2-D echo revealed coronary lesions in 16 of 42 cases: 11 with left and right coronary lesions and 5 with left only, as verified by angio in 15 cases. One case with a small aneurysm of left main coronary artery and one with irregular distal right coronary artery were under-diagnosed by 2-D echo. One patient was over-diagnosed as mild dilatation by 2-D echo. Transient dilatation of coronary arteries was found in two patients. The correlation of severity in coronary dilatation was good in Cr0 (normal) and Cr2 (aneurysmal dilatation), fair in Gr1 (irregular margin or fusiform dilatation) and poor in Gr3 (aneurysmal dilatation with stenosis).
All with coronary lesions received aspirin. Follow-up echo showed regression of the aneurysm in 4 of 13 cases, in another 4, improvement and in 5, no change 1 to 21 months later. In conclusion, 2-D echo proved to be a useful non-invasive method for coronary dilatations and for following u changes, angio was required.

並列關鍵字

Kawasaki disease ； coronary arterial lesions ； two-dimensional echocardiography