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目的探讨选择性冠状动脉造影及三磷酸腺苷负荷超声心动图对川崎病(KD)冠状动脉损害远期追踪的价值。方法选取1999至2007年广州市儿童医院KD急性期超声心动图检查发现合并冠状动脉损害的患儿,同时采用三磷酸腺苷负荷超声心动图及选择性冠状动脉造影于恢复期进行远期随访。结果依据纳入标准和排除标准逐层筛选,确定9例KD患儿为本研究的样本。男8例,女1例,急性期发病年龄为1~10岁,平均(4.44±3.09)岁。检查时年龄4~12岁,平均(7.89±2.62)岁。追踪时间1.5~7年,平均(3.44±1.67)年。急性期超声心动图示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。三磷酸腺苷负荷超声心动图示:节段性室壁运动异常6/9例;冠状动脉血流储备下降5/9例。冠状动脉造影示:双侧主干冠状动脉瘤4例,同时伴远端动脉瘤3处,冠状动脉左前降支狭窄1处,并冠状动脉扭曲,狭窄或充盈缺损3处,附近侧支血管形成1处;左前降支动脉瘤、右冠状动脉闭塞伴侧支循环形成1例,冠状动脉扩张4例。与同期超声心动图检查比较,冠状动脉造影新发现冠状动脉远端瘤3处,右冠状动脉远端狭窄2处,左前降支狭窄1处,右冠状动脉闭塞伴侧支血管形成1例。5例三磷酸腺苷负荷超声心动图检查结果阳性者与冠状动脉造影比较:均发现相应冠状动脉支狭窄或充盈缺损表现;1例三磷酸腺苷负荷超声心动图检查结果阳性,冠状动脉造影仅见轻度冠状动脉扩张。结论KD合并冠状动脉损害特别是动脉瘤造成的心脏损害可长期存在。对于远期追踪观察KD患儿冠状动脉病变,三磷酸腺苷负荷超声心动图具无创、安全可靠的优点,是判断心肌缺血的重要方法;选择性冠状动脉造影可明确显示冠状动脉病变的位置、形态、数目及严重程度,特别对冠状动脉狭窄、闭塞及远端病变能做出准确的评估。两种方法结合检查对KD冠状动脉损害的远期追踪有重要帮助。
Objective To investigate the value of selective coronary angiography and adenosine triphosphate echocardiography in the long-term follow-up of KD coronary artery lesions. Methods From 1999 to 2007, Guangzhou Children’s Hospital, KD acute echocardiography examination found coronary artery lesions in children with adenosine triphosphate stress echocardiography and selective coronary angiography in the recovery of long-term follow-up. Results According to inclusion criteria and exclusion criteria, screening was performed on a case-by-case basis. Nine children with KD were identified as samples of this study. There were 8 males and 1 females, the age of onset was from 1 to 10 years (average 4.44 ± 3.09 years). Check the age of 4 to 12 years, mean (7.89 ± 2.62) years. Tracing time 1.5 to 7 years, mean (3.44 ± 1.67) years. Acute echocardiography in 9 cases of children with coronary artery tumors in 5 cases, 3 cases of coronary aneurysms, 1 case of coronary artery dilatation. Adenosine triphosphate load echocardiography showed: segmental wall motion abnormalities 6/9 cases; coronary flow reserve decreased 5/9 cases. Coronary angiography showed: 4 cases of bilateral main coronary aneurysms, accompanied by distal aneurysm 3, left anterior descending coronary artery stenosis 1, and coronary distortions, stenosis or filling defect 3, near the formation of collateral vessels 1 Department of left anterior descending artery aneurysm, right coronary artery occlusion with collateral circulation formation in 1 case, 4 cases of coronary artery dilatation. Compared with echocardiography in the same period, 3 newly diagnosed coronary arteries, 2 distal stenosis of right coronary artery, 1 stenosis of left anterior descending artery and 1 coronary artery occlusion with collateral vessels were found in coronary angiography. 5 cases of adenosine triphosphate load echocardiography positive results were compared with coronary angiography: the corresponding coronary stenosis or filling defect were found; 1 case of adenosine triphosphate load echocardiography positive results, coronary angiography only mild coronary dilatation. Conclusion KD combined with coronary artery lesions, especially aneurysms caused by heart damage can exist for a long time. For long-term follow-up observation of coronary artery disease in children with KD, adenosine triphosphate load echocardiography with noninvasive, safe and reliable advantages, is an important method to determine myocardial ischemia; selective coronary angiography can clearly show the location of coronary lesions, morphology, Number and severity, especially for coronary stenosis, occlusion and distal lesions can make an accurate assessment. Combined with the two methods of KD coronary artery lesions long-term follow-up of important help.