30例川崎病患儿主动脉造影临床分析

Clinical analysis of aortographic manifestations in 30 child patients with Kawasaki disease

目的 总结武汉儿童医院川崎病(KD)伴冠状动脉病变(CAL)患儿主动脉造影特点。方法 回顾性分析2016年6月至2023年6月在武汉儿童医院接受主动脉造影术检查的30例恢复早期KD伴CAL患儿临床资料。术前超声心动图评估CAL程度,并在喉罩全身麻醉下行主动脉造影术。结果 30例KD伴CAL患儿主动脉造影检查均获成功。造影后CAL风险分级结果显示,Ⅰ级5例,Ⅱ级7例,Ⅲ级12例,Ⅳ级4例,Ⅴ级2例。所有患儿中有冠状动脉陈旧性血栓形成1例(Ⅲb级),冠状动脉狭窄伴侧支循环形成1例(Ⅴ级)。CAL位于右冠状动脉近段15例、中段3例,远段2例,左冠状动脉主干12例,左冠状动脉前降支近段9例。心电图检查提示窦性心律17例,窦性心律不齐4例,右束支传导阻滞4例,房性早搏1例,室性早搏2例,T波改变1例,Q波改变1例(Ⅴ级,心脏彩色超声提示左心扩大),其余患儿均无心脏扩大、心功能不全及瓣膜反流表现。结论 KD伴CAL患儿恢复早期接受主动脉造影检查安全可行。本组KD患儿CAL主要发生在冠状动脉近段,尤其是右冠状动脉近段,以及左主干、左前降支近段。

Objective To summarize the aortographic features of child patients with Kawasaki disease(KD) complicated by coronary artery lesion(CAL) who were treated at the Wuhan Children's Hospital of China.Methods The clinical data of 30 child patients with early recovery stage KD complicated by CAL,who received aortic angiography examination at Wuhan Children's Hospital of China between June 2016 and June2023,were retrospectively analyzed.Preoperative echocardiography was adopted to evaluate the severity of CAL,and aortic angiography under laryngeal mask general anesthesia was performed.Results Successful aortic angiography examination was accomplished in all the 30 child patients with KD complicated by CAL.After angiography,the CAL risk classification results showed that grade I was seen in 5,gradeⅡin 7,gradeⅢin 12,gradeⅢin 4,and grade V in 2 child patients.Of all child patients,old coronary thrombosis was found in one(gradeⅢb),and coronary artery stenosis with collateral circulation formation in one (gradeⅤ).The CAL was located at the proximal segment (n=15),middle segment(n=3) and distal segment(n=2) of the right coronary artery,at the left main coronary artery (n=12),and at the proximal segment of left coronary artery anterior descending branch(n=9).Electrocardiography showed sinus rhythm (n=17),sinus arrhythmia(n=4),right bundle branch block(n=4),atrial premature beat(n=1),ventricular premature beat(n=2),T-wave change(n=1),and Q-wave change(n=1,coronary lesion grade V,echocardiography suggested left heart enlargement).No cardiac enlargement,cardiac functional insufficiency,or valvular regurgitation signs were observed in the remaining child patients.Conclusion It is clinically safe and feasible to perform aortic angiography examination in child patients with early recovery stage KD complicated by CAL.In this series of child patients with KD,CAL mainly occurs at the proximal segment of coronary artery,especially at the proximal segment of right coronary artery as well as at the left main artery and left anterior descending branch.(J Intervent Radiol,2024,32:126-129)