Diagnosis Of Coronary Artery Aneurysm Research Articles

Aetiologic diagnosis of coronary artery aneurysm in a patient with pancreatitis, dacryoadenitis, and sialadenitis.

Aetiologic diagnosis of coronary artery aneurysm in a patient with pancreatitis, dacryoadenitis, and sialadenitis.

Pediatric expert consensus on the application of glucocorticoids in Kawasaki disease.

Kawasaki disease (KD) is one of the common acquired heart diseases in under-5-year-old children and is an acute self-limiting vasculitis. After nearly 60 years of research, intravenous immunoglobulin combined with oral aspirin has become the first-line treatment for preventing coronary artery aneurysm in the acute stage of KD. However, glucocorticoid (GC), infliximab, and other immunosuppressants are options for the treatment of KD patients with a high risk of coronary artery aneurysm, no response to intravenous immunoglobulin and a confirmed diagnosis of coronary artery aneurysm. At present, there are still controversies over the use of GC in the treatment of KD. With reference to the latest research findings of KD treatment in China and overseas, this consensus invited domestic pediatric experts to fully discuss and put forward recommendations on the indications, dosage, and usage of GC in the first-line and second-line treatment of KD.

Identifying children with Kawasaki disease at high risk for coronary aneurysms

Kawasaki disease, a childhood vasculitis manifested by symptoms of high fever, mucocutaneous inflammation, and unilateral cervical adenopathy, can cause lasting damage to the coronary arteries, and more rarely, other medium-sized muscular arteries. Most children respond well to prompt treatment with high-dose intravenous immunoglobulin (IVIG). However, coronary artery aneurysms, defined by internal lumen diameter at least 2.5 SDs above the population mean for body surface area (Z≥2.5), occur in ∼25% of affected children and are the principal cause of long-term morbidity and mortality in Kawasaki disease. Several risk scores have attempted to predict which children are likely to develop coronary aneurysms. In previous studies in North America, baseline risk factors for coronary artery aneurysms on echocardiography performed 2-8 weeks after Kawasaki disease onset have included higher coronary artery dimensions on baseline echocardiography, IVIG resistance (the persistence or recrudescence of fever after a single dose of IVIG), young age (<12 months or <6 months depending upon the risk score), Asian race, and late diagnosis and treatment with IVIG. Japanese risk scores based upon clinical and laboratory variables have been highly accurate in predicting IVIG resistance, one of the strongest risk factors for coronary artery aneurysms. In Japanese children predicted to have high risk of IVIG resistance, primary adjunctive therapy with corticosteroids or cyclosporine has been shown in randomized clinical trials to reduce the incidence of coronary artery aneurysms. However, Japanese children predicted to be at low risk for aneurysms on the basis of laboratory measures may still develop coronary abnormalities. Understanding the risk factors for aneurysm development thus requires further refinement. In this volume of The Journal, Iio et al analyze independent risk factors for development of coronary artery aneurysms in 1632 Japanese children with Kawasaki disease who were predicted to be at low risk for resistance to primary IVIG treatment. In this low-risk group, 5.5% of patients developed any coronary artery aneurysms and 1%, medium or large coronary aneurysms. In multivariable analysis, baseline coronary artery Z score >2.5, age <12 months at fever onset, and IVIG resistance were independent risk factors for diagnosis of coronary artery aneurysms on echocardiography one month after disease onset. Among these risk factors, coronary artery Z score ≥2.5 was most strongly associated with aneurysm development. Taken together with previous literature, these data suggest that enlarged coronary Z scores measured on baseline echocardiography can be used to select children at high risk for subsequent coronary artery aneurysms and thus who may benefit from adjunctive therapy. The study of Iio et al adds weight to the concept that a high-risk cohort for randomized clinical trials of primary adjunctive therapy in Kawasaki disease may be most simply selected through findings on baseline echocardiography. The ability to select such a high-risk cohort is critical to the design of trials to answer remaining questions in Kawasaki disease therapy: In children of all races and ethnicities, who should receive treatment with adjunctive therapies? How do antiinflammatory therapies compare with each other, and what is the cost/benefit ratio for these therapies? Article page 158 Risk Factors of Coronary Artery Aneurysms in Kawasaki Disease with a Low Risk of Intravenous Immunoglobulin Resistance: An Analysis of Post RAISEThe Journal of PediatricsVol. 240PreviewTo detect risk factors of coronary artery aneurysm (CAA) development in patients with Kawasaki disease determined to have a low risk for resistance to primary intravenous immunoglobulin (IVIG) treatment based on the Kobayashi score. Full-Text PDF

Coronary Artery Aneurysm in Kawasaki Disease: Coronary CT Angiography through the Lens of Pathophysiology and Differential Diagnosis.

Kawasaki disease (KD) is an inflammatory autoimmune vasculitis affecting the coronary arteries of very young patients, which can result in coronary artery aneurysms (CAAs) with lifelong manifestations. Accurate identification and assessment of CAAs in the acute phase and sequentially during the chronic phase of KD is fundamental to the treatment plan for these patients. The differential diagnosis of CAA includes atherosclerosis, other vasculitic processes, connective tissue disorders, fistulas, mycotic aneurysms, and procedural sequelae. Understanding of the initial pathophysiology and evolutionary arterial changes is important to interpretation of imaging findings. There are multiple applicable imaging modalities, each with its own strengths, limitations, and role at various stages of the disease process. Coronary CT angiography is useful for evaluation of CAAs as it provides assessment of the entire coronary tree, CAA size, structure, wall, and lumen characteristics and visualization of other cardiothoracic vasculature. Knowledge of the natural history of KD, the spectrum of other conditions that can cause CAA, and the strengths and limitations of cardiovascular imaging are all important factors in imaging decisions and interpretation. Keywords: Pediatrics, Coronary Arteries, Angiography, Cardiac © RSNA, 2021.

Anterior wall myocardial infarction in a 16-year-old man caused by coronary artery aneurysm during the outbreak of COVID-19

BackgroundCoronary artery aneurysm (CAA) is a potential cause of infarction. During the outbreak of coronavirus disease 2019 (COVID-19), home isolation and activity reduction can lead to hypercoagulability. Here, we report a case of sudden acute myocardial infarction caused by large CAA during the home isolation.Case presentationDuring the outbreak of coronavirus disease 2019 (COVID-19),a 16-year-old man with no cardiac history was admitted to CCU of Tang du hospital because of severe chest pain for 8 h. The patient reached the hospital its own, his electrocardiogram showed typical features of anterior wall infarction, echocardiography was performed and revealed local anterior wall dysfunction, but left ventricle ejection fraction was normal, initial high-sensitivity troponin level was 7.51 ng/mL (<1.0 ng/mL). The patient received loading dose of aspirin and clopidogrel bisulfate and a total occlusion of the LAD was observed in the emergency coronary angiography (CAG). After repeated aspiration of the thrombus, TIMI blood flow reached level 3. Coronary artery aneurysm was visualized in the last angiography. No stent was implanted. Intravascular ultrasound (IVUS) was performed and the diagnosis of coronary artery aneurysm was further confirmed. The patient was discharged with a better health condition.ConclusionsCoronary artery aneurysm is a potential reason of infarction, CAG and IVUS are valuable tools in diagnosis in such cases, during the outbreak of coronavirus disease 2019 (COVID-19), home isolation and activity reduction can lead to hypercoagulability, and activities at home should be increased in the high-risk patients.

Imaging of systemic vasculitis in childhood.

The term "systemic vasculitis" encompasses a diverse set of diseases linked by the presence of blood-vessel inflammation that are often associated with critical complications. These diseases are uncommon in childhood and are frequently subjected to a delayed diagnosis. Although the diagnosis and treatment may be similar for adult and childhood systemic vasculitides, the prevalence and classification vary according to the age group under investigation. For example, Kawasaki disease affects children while it is rarely encountered in adults. In 2006, the European League Against Rheumatism (EULAR) and the Pediatric Rheumatology European Society (PReS) proposed a classification system for childhood vasculitis adopting the system devised in the Chapel Hill Consensus Conference in 1993, which categorizes vasculitides according to the predominant size of the involved blood vessels into small, medium and large vessel diseases. Currently, medical imaging has a pivotal role in the diagnosis of vasculitis given recent developments in the imaging of blood vessels. For example, early diagnosis of coronary artery aneurysms, a serious complication of Kawasaki disease, is now possible by magnetic resonance imaging (MRI) of the heart and multidetector computed tomography (MDCT); positron emission tomography/CT (PET/CT) helps to assess active vascular inflammation in Takayasu arteritis. Our review offers a unique approach using the integration of the proposed classification criteria for common systemic childhood vasculitides with their most frequent imaging findings, along with differential diagnoses and an algorithm for diagnosis based on common findings. It should help radiologists and clinicians reach an early diagnosis, therefore facilitating the ultimate goal of proper management of affected children.

Comparison Study of Echocardiography and Dual-Source CT in Diagnosis of Coronary Artery Aneurysm Due to Kawasaki Disease: Coronary Artery Disease

The identification of coronary artery aneurysm (CAA) in the acute and chronic phase of the disease is of prime importance for assessing the likelihood of acute lesions and cardiovascular sequelae. Occasionally, recognition of distal coronary artery has been proven challenging by traditional echocardiography. Our purpose was to evaluate the clinical application of two-dimensional echocardiography (2DE) for detecting CAA caused by Kawasaki disease (KD) and compare with dual-source computed tomography (DSCT). A total of 24 patients with known KD and CAAs were studied by two imaging modalities, i.e., 2DE and DSCT; that is to say, the number, position, shape, and size of each CAA and its association with thrombus, were detected first from echocardiography and then compared with those obtained from DSCT performed on the same day. Meanwhile the diameters of all coronary segments were measured for each patient. Giant aneurysms (GAs) were detected in 5 patients, small and medium coronary aneurysms were identified in 19 patients. The 2DE and DSCT have the same results of proximal coronary artery, whereas conclusion of our comparison of coronary artery visualization indicated that DSCT provided more explicit distal coronary artery than 2DE. A mural thrombus could be clearly delineated in the GAs by DSCT. The 2DE has been demonstrated to be an accurate technique to quantify CAAs in KD. However, DSCT is superior to 2DE for distal coronary artery visualization. Therefore, a combination of echocardiography and DSCT can offer an overview of coronary artery anatomy.

Contrast Staining Outside the Sirolimus-Eluting Stent Leading to Coronary Aneurysm Formation

A 69-year-old man with prior myocardial infarction (hypertension; dyslipidemia; smoking; no diabetes; and no history of allergy, autoimmune disease, or vasculitis) underwent sirolimus-eluting stent (SES) implantation (3.0 mm in diameter; 33 mm in length) for chest pain on exertion with chronic total occlusion of the left anterior descending coronary artery (LAD) (Figure 1A through 1C and Video 1). Intravascular ultrasound examination after SES implantation demonstrated well-expanded stent struts without evidence of incomplete stent apposition (ISA) (Figure 1D through 1F). Figure 1. Baseline angiographic and intravascular ultrasound findings. A, Chronic total occlusion of the proximal LAD before percutaneous coronary intervention (arrow); B, collateral flow into the LAD from the right coronary artery (arrow); C, LAD after SES (3.0 mm in diameter; 33 mm in length) implantation (arrows); D through F, intravascular ultrasound images after SES implantation demonstrating well-expanded stent struts without evidence of incomplete stent apposition. Follow-up angiography at 8 months after initial SES implantation demonstrated multifocal contrast staining outside the stent contour with no evidence of angiographic restenosis (Figure 2A and Video 2). Subsequently, at 16 months after stenting, coronary angiography showed that the areas of contrast staining outside the stent contour increased in size (Figure 2B and Video 3). At 23 months after stenting, coronary artery aneurysm (CAA) formation was demonstrated in the midportion of the SES (Figure 2C and Video 4). The first 8-month …

CT diagnosis of coronary artery aneurysms

Most coronary artery aneurysms are caused by either atherosclerosis or Kawasaki Disease. These lesions can potentially rupture or cause thromboembolic complications. Traditionally, coronary artery aneurysms are diagnosed by conventional coronary angiography. However, as CT coronary artery angiography has been shown to be useful in the visualisation of the larger blood vessels, this imaging modality may well replace conventional angiography as the investigation of choice in the diagnosis of coronary artery aneurysms. Indeed, we present an example where CT coronary angiography has proved useful in the characterisation of the disease.

Multidetector-row computed tomography diagnosis of coronary artery aneurysms and collateral vessel after Kawasaki disease in an adult

A 54-year-old man was referred to our hospital for assessment of an oval calcified mass in the left middle mediastinum on a chest X-ray (Fig. 1). He had an episode of high-grade fever persisting for 10 days when he was 4 years old, but otherwise healthy ever since. His electrocardiogram was normal. Multidetector-row computed tomography (MDCT) was performed with the provisional diagnosis of coronary artery aneurysm. MDCT was performed using an Aquillion 16 (16-detector-row, Toshiba, Japan) with a collimation of 0.5 mm, table feed of 3.2 mm/rotation, 120 kV, 400 mA, and gantry rotation time of 0.4 s. Our scan protocol and image reconstruction method have been reported previously [1]. Metoprolol (40 mg) was given 90 min prior to the scan. Following determination of contrast transit time from the venous injection to the maximum enhancement in the ascending aorta by injecting 15 ml of nonionic contrast medium (Iomeron 350, 100 ml syringe, Eisai, Tokyo, Japan), the remaining contrast medium (85 ml) was injected at a speed of 3.5 ml/s. The heart rate immediately before the scan

Magnetic resonance angiography isequivalent to X-Ray coronary angiography for the evaluation of coronary arteries in kawasaki disease

ObjectivesThe purpose of this study was to compare the results of magnetic resonance angiography (MRA) with X-ray coronary angiography (XCA) in a pediatric population. BackgroundCoronary artery abnormalities in Kawasaki disease (KD) develop in about 15% to 25% of young patients, mostly in the form of aneurysms. MethodsThirteen patients (12 male), age three to eight years, were studied. The maximal diameter and length of the aneurysm were recorded. Coronary MRA was performed using a 1.5 T Philips Intera CV magnetic resonance scanner with an electrocardiographically triggered pulse sequence. It was a three-dimensional segmented k-space gradient–echo sequence (TE = 2.1 ms, TR = 7.5 ms, flip angle = 30°, slice thickness = 1.5 mm) employing a T2-weighted preparation pre-pulse and a frequency selective fat-saturation pre-pulse. Data acquisition was performed in mid-diastole. All scans were carried out with the patient free breathing using a two-dimensional real-time navigator beam. All patients underwent XCA within a week. ResultsIn six patients, aneurysms of the coronary arteries were identified, while coronary ectasia alone was present in the remaining seven patients. Magnetic resonance angiography and XCA diagnosis of coronary artery aneurysm agreed completely. Maximal aneurysm diameter and length and ectasia diameter by MRA and XCA were similar. No stenotic lesion was identified by either technique. ConclusionsIn conclusion, MRA is a reliable diagnostic tool, equivalent to XCA for coronary artery aneurysm identification in patients with KD. Magnetic resonance angiography may prove to be of great value for the serial non-invasive evaluation of these patients.

A Case of Open Heart Surgery in a Patient with Huge Sinoatrial Nodal Artery Aneurysm -A case report-

An intrathoracic mass that manifested compression sign of large vessel and heart by mass was confirmed as huge sinoatrial nodal artery aneurysm and resection of aneurysm was performed. Preoperative precise diagnosis of coronary artery aneurysm is difficult because the most coronary artery aneurysm is incidentally confirmed during diagnostic coronary angiography or autopsy. So huge coronary artery aneurysm which manifests compression sign of large vessel and heart by the mass may be misdiagnosed as simple mediastinal mass. We reports huge coronary artery aneurysm that manifested compression sign of large vessel and heart by the mass with reviews of anesthetic management and diagnostic approach. (Korean J Anesthesiol 1996; 31: 103-108)

Intravascular ultrasound approach to the diagnosis of coronary artery aneurysms

Coronary artery aneurysms are usually diagnosed by contrast coronary angiography, which portrays the silhouette of the lumen but cannot distinguish true and false aneurysms. To differentiate true and false aneurysms and to study the morphologic changes of the vessel wall, intravascular ultrasound (IVUS) was performed in patients with angiographic signs of coronary artery aneurysms. We used a 4.8F or 3.5F, 20 MHz IVUS catheter for ultrasound examination. Fourteen patients (12 men and two women ranging in age from 43 to 73 years) with angiographic signs of coronary aneurysm were enrolled. IVUS imaging was optimally obtained in all patients. The vessel area, lumen area, and plaque area of the aneurysm segment and of the proximal and distal segments were determined. IVUS showed that both the proximal and distal reference segments were severely affected by atherosclerotic lesions in all the patients and by calcium deposits in six patients. The percent stenoses were 63.0% ± 13.7% and 60.9% ± 17.8% in the proximal and distal reference segments, respectively. In nine patients the walls of the aneurysms showed signs of atherosclerosis. Three angiographically indicated aneurysms were found to be plaque ruptures. Although the lumen and the vessel areas of the aneurysm segments were larger than those of the proximal and distal segments ( p < 0.01 and ( p < 0.001), no significant differences in plaque area and plaque composition were found between the aneurysm segment and adjacent vessel segments ( p > 0.05). In conclusion, IVUS allows detailed characterization of coronary aneurysms. Atherosclerosis seems to play an important role in the formation of acquired coronary aneurysms.

Cross-sectional echocardiographic diagnosis of coronary artery aneurysms in patients with the mucocutaneous lymph node syndrome.

Real-time cross-sectional echocardiographic studies revealed the presence of coronary artery aneurysms in five patients with mucocutaneous lymph node syndrome. These lesions appeared as circular echo-free spaces with clearly-defined borders in sites corresponding to angiographically proven aneurysms. In 15 normal subjects who were studied only by noninvasive methods, and in 17 who had normal coronary arteriograms (including eight with the mucocutaneous lymph node syndrome), we found no similar echo findings. The aneurysms were in both right and left coronary arteries in three patients, and were confined to the left side in two. The mucocutaneous lymph node syndrome is an increasingly common condition in Japan which may be fatal due to myocardial infarction occurring in a setting of coronary aneurysm with thrombosis. Therefore, the ability to demonstrate coronary aneurysms noninvasively is of prognostic and potentially therapeutic value in this inadequately understood syndrome.