选择性冠状动脉造影在远期追踪小儿川崎病冠状动脉损害中的作用(附9例报告)

The value of selective coronary angiography for long-term follow-up of children with coronary artery lesions by Kawasaki disease

目的探讨选择性冠状动脉造影术在川崎病远期随访中的作用及该技术应用于儿童的安全性、有效性。方法采用选择性冠状动脉造影术，对1999-2007年广州市妇女儿童医疗中心确诊为川崎病且合并冠状动脉损害患儿9例于恢复期进行检查。本组患儿男8例，女1例，急性期发病年龄为1～10岁，平均（4．44±3．09）岁；行造影时的年龄4～12岁，平均（7．89±2．62）岁。急性期超声检出9例患儿中冠状动脉巨瘤5例，冠状动脉瘤3例，冠状动脉扩张1例。结果冠状动脉造影发现：双侧多发性动脉瘤4例，左前降支动脉瘤、右冠脉闭塞伴侧枝循环形成1例，冠状动脉扩张4例。与同时期超声检查比较，冠状动脉造影新发现冠脉远端瘤2例，右冠状动脉远端狭窄2例，左前降支狭窄1例，右冠状动脉闭塞伴侧枝血管形成1例。结论选择性冠状动脉造影检查儿童川崎病冠状动脉病变安全、可靠，并发症少，特别对冠状动脉狭窄、闭塞及远端病变能做出准确的评估，对川崎病患儿的远期追踪及指导临床治疗具有重要帮助。

Objective To assess the safety and the validity of selective coronary angiography （SCAG） for long-term follow-up of patients with coronary artery lesions by Kawasaki disease. Methods The SCAG was done on 9 children （ 1 female and 8 males） with a history of Kawasaki disease（5 with giant coronary aneurysms,3 with coronary aneurysms,and 1 with dilatation of bilateral coronary arteries in acute stage）. The average age of the patients when SCAG was done was 7. 89 ± 2. 62 years old （ age from 4 - 12 years）. Results The SCAG showed ： the multiple bilateral coronary aneurysms in 4 cases （3/4with mild coronary stenosis ） ; left anterior descending coronary aneurysms with right coronary artery occlusion and collateral branches in 1 case ; dilatation of coronary arteries in 1 cases. Compared with SCAG, echocardiography didnt find distal coronary aneurysms in 2 cases, coronary stenosis in 3 cases and coronary collateral branches in 1 case. Conclusion The selective coronary angiography is safe and reliable to evaluate the coronary artery lesions by Kawasaki disease, especially in finding coronary stenosis,distal aneurysms and coronary collateral branches. It is necessary to perform SCAG for long-term follow-up in patients with coronary artery lesions by Kawasaki disease.