In spite of initial intravenous immunoglobulin(IVIG) treatment, a significant number of patients are unresponsive to it and are at a higher risk for coronary artery lesions. Corticosteroids have been used as a seconda...In spite of initial intravenous immunoglobulin(IVIG) treatment, a significant number of patients are unresponsive to it and are at a higher risk for coronary artery lesions. Corticosteroids have been used as a secondary drug or used in combination with IVIG. Three options of using corticosteroids for the treatment of patients during the acute phase of Kawasaki disease, havebeen considered. The first is their use exclusively for patients unresponsive to IVIG treatment. The second is their use in combination with IVIG as the routine first line therapy for all patients. The last is the use in the combination as the first line therapy for selected patients at a high risk being unresponsive to initial IVIG. However, it is uncertain that the corticosteroids as the second line treatment are better than the additional IVIG in patients unresponsive to initial IVIG. The combination of corticosteroids and IVIG as the routine first line therapy also have not enough evidences. The last option of using corticosteroids- the combination of corticosteroids and IVIG in patients at high risk of unresponsiveness, is a properly reasonable treatment strategy. However, there have been no globally standardized predictive models for the unresponsiveness to initial IVIG treatment. Therefore, future investigations to determine the best predictive model are necessary.展开更多
Bland-White-Garland syndrome is a rare syndrome with anomalous origin of the left coronary artery (LCA) arising from the pulmonary artery, resulting in left ventricular failure. It could occur shortly after birth. We ...Bland-White-Garland syndrome is a rare syndrome with anomalous origin of the left coronary artery (LCA) arising from the pulmonary artery, resulting in left ventricular failure. It could occur shortly after birth. We here reported the case of a 6-week-old boy with aortostenosis. Coronary angiography revealed an anomalous LCA arising from the pulmonary artery. Representation of a prominent right coronary artery (RCA) delivered numerous collateral vessels to the LCA area.The patient underwent a correction operation with translocation of the LCA and re-implantation into the ascending aorta. One month after operation, clear decrease in the expanded ventricle was noted with an increase in the contractibility.展开更多
文摘In spite of initial intravenous immunoglobulin(IVIG) treatment, a significant number of patients are unresponsive to it and are at a higher risk for coronary artery lesions. Corticosteroids have been used as a secondary drug or used in combination with IVIG. Three options of using corticosteroids for the treatment of patients during the acute phase of Kawasaki disease, havebeen considered. The first is their use exclusively for patients unresponsive to IVIG treatment. The second is their use in combination with IVIG as the routine first line therapy for all patients. The last is the use in the combination as the first line therapy for selected patients at a high risk being unresponsive to initial IVIG. However, it is uncertain that the corticosteroids as the second line treatment are better than the additional IVIG in patients unresponsive to initial IVIG. The combination of corticosteroids and IVIG as the routine first line therapy also have not enough evidences. The last option of using corticosteroids- the combination of corticosteroids and IVIG in patients at high risk of unresponsiveness, is a properly reasonable treatment strategy. However, there have been no globally standardized predictive models for the unresponsiveness to initial IVIG treatment. Therefore, future investigations to determine the best predictive model are necessary.
文摘Bland-White-Garland syndrome is a rare syndrome with anomalous origin of the left coronary artery (LCA) arising from the pulmonary artery, resulting in left ventricular failure. It could occur shortly after birth. We here reported the case of a 6-week-old boy with aortostenosis. Coronary angiography revealed an anomalous LCA arising from the pulmonary artery. Representation of a prominent right coronary artery (RCA) delivered numerous collateral vessels to the LCA area.The patient underwent a correction operation with translocation of the LCA and re-implantation into the ascending aorta. One month after operation, clear decrease in the expanded ventricle was noted with an increase in the contractibility.
