川崎病患者选择性冠状动脉造影单中心特点及经验分析

Analysis of coronary artery lesion in patients with Kawasaki disease in single center based on selective coronary angiography

目的总结昆明市儿童医院川崎病并发严重冠状动脉病变(coronary artery lesion,CAL)患者选择性冠状动脉造影(coronary angiography,CAG)的特点及经验。方法回顾性分析2017年7月至2019年10月在昆明市儿童医院行CAG的32例川崎病患儿临床资料,男23例,女9例,年龄5岁5个月(10个月~12岁8个月),体质量19.8(7.5~41)kg。上述患儿术前超声心动图评估CAL临床严重程度分级均在Ⅲ级及以上或心电图有缺血性改变。患者在静脉吸入复合麻醉下行CAG检查,在左心室舒张末期测量CAL内径、长度及位置。总结病变特点及经验,术后根据CAG结果给予个体化治疗。结果 32例患儿均成功施行CAG检查,造影后CAL临床严重程度分级:I级8例,Ⅲ级7例,Ⅳ级10例,Va级7例。共有病变66处,平均每例患儿病变2.06处。病变类型分析:小型动脉瘤或扩张37处(占总数的56.1%),中型动脉瘤17处(占总数的25.8%),巨大动脉瘤3处(占总数的4.5%),狭窄7处,闭塞2处。病变位置分析:左主干病变16处(占总数的24.6%),左前降支近端17处(占总数的26.2%)、中段2处,回旋支近端4处,右冠状动脉近端20处(占总数的29.2%)、中段5处,远端2处。结论对川崎病合并CAL患儿进行CAG检查安全、可行,本中心川崎病严重CAL主要发生在心外膜下冠状动脉近端,特别是右冠状动脉近端、左前降支近端及左主干。巨大动脉瘤瘤体较长,常伴有出口狭窄或闭塞,对于巨大动脉瘤患儿,需要加强抗栓治疗及随访观察。

Objectives To analyze the characteristics of selective coronary angiography(CAG)in patients with Kawasaki disease(KD)complicated with severe coronary artery lesion(CAL)in Kunming Children′s Hospital.Methods Retrospective analysis was performed on the clinical data of 32 children 23 males,9 females,with an average age of5 years and 5 months[10 months-12 years and 8 months,weight of 19.8(7.5-41)kg]with KD-CAL who underwent CAG in Kunming Children′s Hospital from July 2017 to October 2019.The clinical severity of CAL evaluated by echocardiography was gradeⅢor above,or there was ischemic change in electrocardiogram(ECG).CAG was done under general anesthesia in these patients.Diameter,length and location of CAL during left ventricular end-diastolic period.Characteristics and experiences of the lesions were analyzed.Individualized treatment and follow-up plan were given according to the results of CAG.Results All the patients successfully underwent selective CAG.Patients were re-graded as gradeⅠin 8 cases,gradeⅢin 7 cases,gradeⅣin 10 cases and grade Va in 7 cases by the results of CAG.There was a total of 66 CAL in these patiens,with an average of 2.06 CAL per patient.Type analysis:there were 37 small aneurysms or dilations(56.1%),17 medium aneurysms(25.8%),3 giant aneurysms(4.5%),7 stenosis and 2 occlusion.Position analysis:there were 16 lesions in the left main artery(24.6%),17 lesions in the proximal part of the left anterior descending branch(26.2%),2 lesions in the middle part,4 lesions in the proximal part of the circumflex branch,20 lesions in the proximal part of the right coronary artery(29.2%),5 lesions in the middle part and 2 lesions in the distal part.Conclusions CAG is safe and feasible in children with KD-CAL.In our center,severe KD-CAL mainly occurs in the proximal epicardial coronary artery,especially in the proximal right coronary artery,the proximal left anterior descending branch and the left main artery.The giant aneurysm often accompanied by outlet stenosis or occlusion,for the patient with giant aneurysm,it is necessary to strengthen antithrombotic treatment and follow-up observation.