Circulation. 2000;101:e156-e157
(Circulation. 2000;101:e156.)
© 2000 American Heart Association, Inc.
Circulation Electronic Pages |
Coronary Aneurysms in Kawasaki’s Disease Detected by Magnetic Resonance Coronary Angiography
Sebastian Flacke, MD;
Randy M. Setser, MS;
Philip Barger, MD;
Samuel A. Wickline, MD;
Christine H. Lorenz, PhD
From the Center for Cardiovascular MR, Cardiovascular Division,
Barnes-Jewish Hospital at Washington University Medical Center, St Louis, Mo.
Correspondence to Christine H. Lorenz, PhD, Associate Professor of Medicine, Director, Center for Cardiovascular MR, Cardiovascular Division, Box 8086, Barnes-Jewish Hospital at Washington University Medical Center, 216 S Kingshighway Blvd, St Louis, MO 63110. E-mail chl{at}ccmr.wustl.edu
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Introduction
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A20-year-old woman
with a history of Kawasaki’s disease
as a child and coronary
aneurysms underwent cardiac MRI for
reevaluation before an
intended pregnancy. The patient regularly
participated in athletic
activities, and the physical examination
was unremarkable. The ECG
showed normal sinus rhythm and nonspecific
T-wave abnormalities in the
precordial leads. MRI (1.5-T ACS-NT,
Philips Medical Systems)
revealed normal left ventricular size
and function. During
an exercise stress test performed at the
scanner with an MRI-compatible
ergometer, the patient achieved
90% maximal predicted heart rate with
no segmental wall abnormalities
at peak exercise. ECG-triggered and
navigator-gated and -corrected
3D coronary MR angiography was
performed, demonstrating aneurysms
of both the left and
right coronary arteries (Figure 1
). A turbo-field
echo pulse sequence
incorporating a T2 preparation pulse to
enhance
blood-myocardium contrast was used.
1 Images
were acquired
over multiple heartbeats with a 63-ms acquisition window
in
middiastole. Separate oblique data sets were acquired
for the
left and right coronary arteries. Both the right
coronary artery
and the left anterior descending
coronary artery (LAD) could
be clearly delineated up to 5.5 cm
from their origin. Multiplanar
reformats show a large aneurysm,
14
x16
x11 mm in diameter, of
the proximal LAD at the junction of
the left main, LAD, and
left circumflex coronary arteries and a
smaller aneurysm, 6
mm in diameter, in the proximal right
coronary artery (Figures
2
and 3
).
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Figure 1. Single image of 3D data set acquired to delineate
right coronary artery. Small aneurysm in proximal right
coronary artery is seen (small arrow), as well as a large
circular aneurysm of LAD filling left
atrioventricular groove (large arrow). Ao indicates
aorta; PA, pulmonary artery; LA, left atrium; and RA, right
atrium.
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Figure 2. Multiplanar reformatted image of right
coronary artery with a small aneurysm near its origin
(arrow). Aneurysm is 6 mm in diameter. No associated
stenosis is seen in remaining course of right coronary
artery. Abbreviations as in Figure 1 .
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Figure 3. Large aneurysm is seen in LAD on
reformatted image (arrow). Flow-related signal within aneurysm
is homogeneous, with no evidence of thrombosis. LAD and
left circumflex artery arise directly from aneurysm.
Abbreviations as in Figure 1.
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Footnotes
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister,
Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal
Hospital and Texas Heart Institute, and Clinical Professor of
Pathology, University of Texas Medical School and Baylor College
of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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References
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Brittain JH, Hu BS, Wright GA, Meyer CH, Macovski A,
Nishimura DG. Coronary angiography with magnetization-prepared
T2 contrast. Magn Reson Med. 1995;33:689–696.[Medline]
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