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(Circulation. 2002;106:887.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

"Arteries Within the Artery" After Kawasaki Disease

A Lotus Root Appearance by Intravascular Ultrasound

Mitsuyasu Terashima, MD; Kojiro Awano, MD; Yasuhiro Honda, MD; Nagisa Yoshino, MD; Takao Mori, MD; Hideki Fujita, MD; Yoshitaka Ohashi, MD; Osamu Seguchi, MD; Katsuya Kobayashi, MD; Masakazu Yamagishi, MD; Peter J. Fitzgerald, MD, PhD; Paul G. Yock, MD; Kazumi Maeda, MD

From Miki City Hospital, Miki, Japan (M.T., K.A., N.Y., T.M., H.F., Y.O., O.S., K.K., K.M.); Stanford University, Stanford, Calif (Y.H., P.J.F., P.G.Y.); and National Cardiovascular Center, Suita, Japan (M.Y.).

Correspondence to Paul G. Yock, MD, Biodesign, 269 Campus Dr, CCSR-4125, Stanford, CA 94305-5192. E-mail yock@stanford.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A26-year-old man underwent cardiac catheterization because of abnormal electrocardiography (QS in leads V₁ to V₃) and thallium stress scintigraphy (a fixed defect in the anteroseptal wall). The patient had a history of suspected Kawasaki disease with sudden cardiac arrest at the age of 1 year. Coronary angiography showed no significant aneurysm, occlusion, or stenosis but a mild dilatation with a braid-like appearance at the proximal segment of the left anterior descending artery (LAD) (Figure 1). Intravascular ultrasound (IVUS) revealed that this segment was composed of multiple channels. The channels were connected to the septal branch, the diagonal branch, and the distal LAD (Figure 2), suggesting spontaneous recanalization of the thrombotic LAD occlusion due to coronary vasculitis with Kawasaki disease. This lotus root-like appearance detected in vivo by IVUS presumably corresponds to the "arteries within the artery" phenomenon reported in a previous pathological study of Kawasaki disease.

View larger version (125K): [in this window] [in a new window]   Figure 1. The LAD showed an unusual lesion resembling a braid (left anterior oblique view).

View larger version (123K): [in this window] [in a new window]   Figure 2. IVUS with a saline flush revealed multiple channels in the LAD (upper). Longitudinal reconstruction of IVUS image showed that each channel was connected to the branches or the distal LAD (lower).*The first septal branch.

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 . . . [Full Text of this Article]

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