Hiroshi Kanamaru

Characteristics of earlier atherosclerotic involvement in adolescent patients with Kawasaki disease and coronary artery lesions: Significance of gray scale median on B-mode ultrasound

OBJECTIVEnTo test the hypothesis that textural changes in the carotid intima-media complex (IMC) detected by B-mode ultrasound are associated with the difference of remodeling process in earlier atherosclerotic involvement in patients with Kawasaki disease (KD) and coronary artery lesions (CALs).nnnMETHODSnEighteen patients with KD and CALs (mean age 17.2 years), 17 patients with heterozygous familial hypercholesterolemia (FH) (mean age 16.9 years) and 15 age-matched healthy controls (Cont) were assessed and compared for carotid intima-media thickness (CIMT), elastic property (E(p)), and first- and second-order statistics.nnnRESULTSnKD showed significantly higher gray scale median (GSM) than FH and Cont. KD and FH showed significantly higher CIMT, entropy and lower angular second moment than Cont, but no significant difference was found between KD and FH.nnnCONCLUSIONnHigher GSM in KD may indicate alteration of tissue components and heterogeneity of IMC, suggesting the development of arteriosclerotic vascular remodeling after vasculitis. This is distinct from that of atherosclerosis with lower GSM often observed in FH.

Non-invasive measurement of coronary flow reserve in children with Kawasaki disease

Objective: To investigate whether transthoracic Doppler echocardiography (TTE) can reliably measure the coronary flow reserve in the left anterior descending coronary artery in children with Kawasaki disease. Design: Coronary flow velocity in the distal left anterior descending coronary artery was measured by TTE and was compared with that obtained by intracoronary Doppler guide wire. The ratio of maximum hyperaemia (intravenous administration of adenosine triphosphate, 160 μg/kg/min) to baseline peak (mean) diastolic coronary flow velocity in the distal artery was used as an estimate of coronary flow reserve. Setting: University hospital. Patients: 10 patients with significant left anterior descending coronary stenosis (> 70% diameter stenosis) (group A) in the proximal or middle portion of the artery and 14 patients (group B) without significant stenosis, all with Kawasaki disease documented by previous coronary angiography. Results: The reduced hyperaemic coronary flow velocity in group A compared with group B resulted in a markedly lower coronary flow reserve, derived from both peak diastolic velocity and mean diastolic velocity by either technique of investigation. Multivariate analysis identified the best predictor of left anterior descending coronary artery stenosis to be a coronary flow reserve of ≤ 2.2, derived from mean diastolic flow velocity measured using TTE (sensitivity 90%, specificity 100%, accuracy 96%). A good correlation was found between diastolic velocity derived values for coronary flow reserve measured using both TTE and Doppler guide wire (r = 0.92, p = 0.0001). Conclusions: Coronary flow reserve in the distal left anterior descending coronary artery can be accurately measured using TTE without any intravascular instrumentation in children with Kawasaki disease.

Longitudinal study of parental smoking habits and development of asthma in early childhood.

OBJECTIVEnThis study examined the association between parental smoking habits and the development of asthma in early childhood by using representative samples.nnnMETHODSnThe survey subjects included all of the 53,575 babies born in Japan during the periods January 10-17 and July 10-17, 2001. The families of the subjects were asked to complete questionnaires that were delivered by post at 6 months, 1 year 6 months, 2 years 6 months, 3 years 6 months, and 4 years 6 months postpartum. The first survey contained questions regarding the smoking habits of the parents. The second to fifth surveys asked if the child had needed medical attention for the treatment of asthma.nnnRESULTSnData from 36,888 subjects (collection rate: 68.9%) were analyzed. The 4-year cumulative incidence of asthma was 12.0%. Maternal indoor smoking significantly increased the risk of asthma development in children, 4-year risk 14.4% vs. 11.7%, risk ratio=1.24, 95% CI: 1.11 to 1.38. No statistically significant association was found between paternal smoking and asthma development in children.nnnCONCLUSIONSnIn order to prevent the development of asthma in early childhood, it is necessary to formulate measures to stop or discourage maternal smoking.

Assessment of coronary artery abnormalities in a patient with Kawasaki disease by multislice computed tomography

The high spatial resolution of multislice computed tomography (MSCT) permits direct visualization of the coronary artery system. In this report, we describe coronary artery abnormalities in a young adult with Kawasaki disease. MSCT detected a giant coronary artery aneurysm, coronary artery stenosis in the first diagonal artery, and a multi-layered structure in the right coronary artery and the left circumflex artery. These findings corresponded well to those obtained by coronary angiography. MSCT has the potential to be the standard diagnostic tool for the follow-up evaluation of coronary artery disease in adolescents and young adults with Kawasaki disease.

Detection of myocardial contractile reserve by low-dose dobutamine quantitative gated single-photon emission computed tomography in patients with Kawasaki disease and severe coronary artery lesions

We studied 24 patients with severe coronary artery lesions to assess myocardial perfusion and left ventricular contractile reserve simultaneously using low-dose dobutamine quantitative electrocardiographically gated single-photon emission computed tomography in patients with Kawasaki disease. Low-dose dobutamine infusion was started after an injection of technetium-99m tetrofosmin at rest. Myocardial contractile reserve was evaluated using the post-stress and low-dose dobutamine images, and myocardial perfusion was evaluated using the stress and rest images. Quantitative electrocardiographically gated single-photon emission computed tomography during low-dose dobutamine infusion is a useful and safe method for the combined evaluation of myocardial contractile reserve and myocardial perfusion.

Changes in the Textural Characteristics of Intima-Media Complex in Young Patients with Familial Hypercholesterolemia: Implication for Visual Inspection on B-Mode Ultrasound

BACKGROUNDnTo test the hypothesis that textural changes in the carotid intima-media complex (IMC) on visual inspection by B-mode ultrasound are associated with early atherosclerotic involvement in patients with heterozygous familial hypercholesterolemia (FH).nnnMETHODSn55 patients (mean age 13.4 years) were categorized into three groups according to the degree of thickness in IMC (intima-media thickness [IMT]) (groups I-III) and 15 healthy controls within the same age range as the patients were assessed for first- and second-order statistics and visual scoring of textural changes in IMC (1, normal; 2, proximal interface disruption; 3, granulation).nnnRESULTSnThere was no significant difference in first-order statistics among the four groups. As for second-order statistics, groups II (moderately increased IMT) and III (markedly increased IMT) had significantly higher entropy and lower angular second moment than group I (normal IMT) and control. Likewise, groups II and III received significantly higher visual scoring than group I. Visual scoring correlated with entropy (rxa0= 0.57) and angular second moment (rxa0=xa0-0.50). Multiple regression analysis identified entropy (betaxa0= 0.52) and visual scoring (betaxa0= 0.42) as significant determinants of IMT.nnnCONCLUSIONSnThese findings demonstrate that higher visual scoring may indicate dishomogeneity of IMC, suggesting early medial infiltration. This seems to be a simple visual marker to more effectively identify high-risk young patients with FH.

MDCT of the anomalous origin of the right coronary artery from the left sinus of Valsalva associated with bicuspid aortic valve

Anomalous origin of the right coronary artery is a relatively rare coronary artery anomaly which is known to cause myocardial ischemia and sudden death. Association of anomalous origin of the right coronary artery with congenital bicuspid aortic valve is even rarer with only a few cases being reported previously. We describe, for the first time, MDCT findings of anomalous origin of the right coronary artery associated with congenital bicuspid aortic valve.

Dual myocardial scintigraphy mismatch in an infant with Bland-White-Garland syndrome

Bland-White-Garland syndrome (BWG) is a rare disorder that includes abnormalities of the coronary arteries that cause severe myocardial ischemia or infarction in infancy. In this case report, we describe an infant with BWG evaluated by dual single photon emission computed tomography using thallium-201 and I-123 beta-methyl-p-iodophenyl-pentadecanoic acid before and after surgery.

Successful multiple coils embolization for bilateral patent ductus arteriosus with isolated subclavian artery

Gianturco coil embolization is commonly performed to close a patent ductus arteriosus (PDA). 1 – 3 Multiple Gianturco coils are often used for medium or large PDA. 4 Isolation of the left subclavian artery (ILSCA) in a patient with a right aortic arch with bilateral PDA is a rare abnormality. 5,6 No patient has been reported in whom multiple occlusion coils were deployed to both PDA. In the present paper we report a patient whose bilateral PDA with ILSCA were successfully occluded using multiple Gianturco coils.

Estimation of “Selective” Intravenous Gamma Globulin Treatment Indicated by Harada Score

Harada score, which was originally constructed as a guideline for indication of intravenous gamma globulin (IVGG) in research group of Kawasaki disease promoted by the Ministry of Health (Kouseishou), had been applied to consecutive 258 cases of Kawasaki disease between 1989 and 1998. Each item of score are regarded as positive when patient is male, 12-month-old or younger, white blood cell count is 12,000/mm3 or more, platelet count is less than 350,000/mm4C-reactive protein is 4.0mg/dl or more, hematocrit is less than 35%, serum albumin is less than 3.5g/dl. Concerning to these items, 203 cases (78.7%) fulfilled 4 or more items and were treated with IVGG. Among them, coronary artery lesion (CAL) developed in 28 cases (13.8%) at 30th day after onset and remained after 1 year in 19 cases (7.4%). Giant aneurysm larger than 8mm in diameter developed in 3 cases (1.5%). Fifty-five cases fulfilled 3 or fewer items and were not treated with IVGG. CAL developed in 2 cases (3.6%) at 30th day and both of them regressed to discontinue medication until 1 year after onset. Frequency of blood examinations while patient is in hospital were done every 3.13±0.87 days in cases during 3 years from 1986 to 1988 before Harada score was evaluated, while during 10 years of this study examinations were done every 3.06±0.46 days in cases that IVGG was indicated, and 2.81±0.68 days in cases that IVGG was not indicated. Harada score has utility with 93.3% and 100% of sensitivity at 30th day and over 1 year respectively, for selection of cases which IVGG is absolutely necessary for prevention of CAL. Though frequency of blood tests tends to increase, statistics concerning to it was not significant.