Transthoracic ultrasonic visualisation of coronary aneurysm, stenosis, and occlusion in Kawasaki disease

Abstract

Objective-To determine the sensitivity and specificity of our transthoracic echocardiographic technique using high frequency (7.5 MHz) transducers for identification of the presence and type of coronary artery disease in patients with Kawasaki disease. Design-The results of the prospective echocardiographic study in each of seven segments of the four major coronary arteries were compared with the selective coronary angiograms. Setting-Kitasato University Hospital. Subjects-60 patients with Kawasaki disease, ranging in age from 8.0 months to 22 years (median, 6.0 years). Results-Adequate echocardiographic images were obtained in 397 (95%) of 420 coronary segments. Coronary angiography showed the presence of coronary aneurysms in 87 segments and stenosis or occlusion in 28. The overall sensitivity and specificity of cross sectional echocardiography for correctly identifying coronary aneurysms were 95% and 99%, respectively; for correctly identifying coronary stenosis or occlusion the values were 85% and 98% for the right coronary artery, and 80% and 97% for the left anterior descending coronary artery. Agreement on the presence or absence of coronary aneurysms and obstructive lesions on echocardiograms between the two observers was 1.0 and 0.98, respectively. Conclusions-Echocardiography may provide a non-invasive means of identifying the presence and type of coronary artery disease in patients with Kawasaki disease. (Heart 2000;83:400-405)

Cardiac Magnetic Resonance Imaging for Noninvasive Assessment of Cardiovascular Disease During the Follow-Up of Patients With Kawasaki Disease

“…In addition, echocardiography may be limited by operator dependency and becomes progressively more difficult when a child grows and body size increases. 6 Nuclear perfusion scans are recommended to address ventricular function in relation to vascularization and ischemia with modest specificity, while resulting in high radiation exposure. [7][8][9] Conventional coronary angiography is the gold standard for coronary artery evaluation and is able to detect CAAs, coronary artery stenosis, and thrombotic occlusion but results in risks associated with its invasive nature and the exposure to contrast and radiation.…”

Application of prospective ECG-triggered dual-source CT coronary angiography for infants and children with coronary artery aneurysms due to Kawasaki disease

“…So it is important to carry out a thorough assessment of the whole coronary artery, including the distal coronary artery. TTE is the main imaging modality in children to evaluate proximal coronary artery disease and direction of flow [32,33]. However, visualisation of the distal coronary artery segments using TTE is limited owing to deterioration of the acoustic window [20,33,34].…”

Transthoracic Echocardiography in the Assessment of Coronary Arteries

“…Frommelt, 2004). Thus, the overall sensitivity and specificity of TTE for accurate identification of coronary aneurysms are 95% and 99%, respectively (Hiraishi et al, 2000). Unlike aneurysms, direct visualization of atherosclerotic plaques in non-dilated or mild-dilated coronary arteries with the help of TTE is rather an exception.…”

“…In adults, TTE is successfully attempted for detection of coronary artery anomalies, arteriovenous fistulas, and coronary aneurysms (Harada et al, 1999;Hiraishi et al, 2000; P.C. Frommelt & M.A.…”

“…Until recently, transthoracic echocardiography (TTE) evaluation of the CAD was aimed at the assessment of regional and global left ventricular function (Youn & Foster, 2004). Direct transthoracic visualization of the coronary arteries was attempted in children and occasionally in adults with coronary artery anomalies, arteriovenous fistulas, and aneurysms (Harada et al, 1999;Hiraishi et al, 2000; P.C. Frommelt & M.A.…”