Abstract 14875: Evaluation Of Coronary Arteries Using Mutli-detector X-ray Computed Tomography In Pediaric and Young Adult Patients With Giant Coronary Aneurysms Caused By Kawasaki Disease
[AIM] To determine usefulness of multi-detector x-ray computed tomography (MDCT) in the evaluation of coronary arteries in patients with giant coronary aneurysms (GAA) caused by Kawasaki disease (KD).
[METHODS] Subjects were 28 pediatric and young adult patients (19 male and 9 female) with history of KD who had GAA with > 8.0 mm of coronary artery diameter confirmed by coronary angiography (CAG) soon after the onset. Using MDCT, calcification of the coronary arteries was identified and these segments were compared with the finding in CAG at acute phase. In addition, character of internal lumen was evaluated in these calcified segments.
[RESULTS] Patient's age at onset and at study were 2.8 ± 3.0 and 23.6 ± 7.0 (10.8-40.4) years old, with median of 21.4 (9.8-40.1) years of observational period. In these 28 patients, 16 (57%) underwent either catheter or surgical interventions for coronary stenosis. On MDCT, 27 (96%) of 28 patients showed calcification of the coronary arteries in total of 58 segments (2.1 ± 1.0, range 1-4 segments for each patient). These calcifications primarily located proximal coronary arteries with 17 in segment 1, 8 in segment 2, 7 in segment 3, 10 in segment 5, 11 in segment 6, and 5 in segment 11. In these 58 segments, GAA presented in 44 (76%) segments, small to moderate aneurysms with diameter < 8.0mm in 13 (22%), and no dilation in 1 (2%) on CAG in acute phase. Conversely, these 44 calcified segments accounted for 90% of 49 segments where GAA presented in acute phase. Of 49 segments where calcification presented with patent coronary lumen, we could evaluate the degree of stenosis in 29 segments, but it was not possible in the remaining 20 segments (41%) because of interference with calcifications.
[CONCLUSIONS] Most of the GAA after KD showed calcification at more than 10 years after the onset. Furthermore, small to moderate coronary aneurysm or even normally appeared coronary arteries may develop calcification with time. These calcifications can preclude accurate evaluation of the internal lumen with current setting of the MDCT, hence other modalities including CAG or cardiac magnetic resonance imaging must be the choice of diagnostic test in these patients.
- © 2011 by American Heart Association, Inc.