Osahiro Takahashi

Coronary arterial lesions of Kawasaki disease: cardiac catheterization findings of 1100 cases.

SummaryIn our institute, 1100 patients with a history of Kawasaki disease have been catheterized for selective coronary arteriography. Their age at examination ranged from four months to 13 years. Coronary artery lesions (CAL) were found in 262 patients. As far as the type of the CAL was concerned, occlusion was noted in 20 (7.6%), segmental stenosis in 15 (5.7%), localized stenosis in 62 (23.7%), aneurysm in 93 (35.5%), and dilatation in 72 patients (27.5%). In terms of the total number of lesions, there were 23 occlusions, 19 segmental stenoses, 109 localized stenoses, 449 aneurysms and 307 dilatations.The 262 patients with CAL were analyzed according to the interval from the onset to the time of selective coronary arteriography. The incidence of both occlusion and segmental stenosis was lowest in the group who were catheterized shortly after the onset of disease, whereas the prevalence of aneurysm was highest in this group. But the prevalence of dilatation was highest in the group of patients who were catheterized late. A total of 12 patients had to undergo femoral arterial thrombectomy for arterial thrombosis following the catheterization, but no other major complication was experienced.

Usefulness of left ventricular volume in assessing tetralogy of fallot for total correction

Ninety-one patients with tetralogy of Fallot underwent intracardiac repair between 1978 and 1981. One patient died from left-sided heart failure. Retrospective analyses of this death revealed a significant decrease of the left ventricular (LV) end-diastolic volume index (EDVI) of 21 ml/m2 (36% of normal). Results of early postoperative hemodynamic studies after total correction of this anomaly suggested that an EDVI of 30 ml/m2 is the minimal requirement for adequate cardiac output postoperatively. Based on these data, 3 patients with decreased LV volume with EDVI of around 30 ml/m2 were challenged with the primary repair with success, although they required atrial pacing and catecholamine support postoperatively to maintain adequate left atrial pressure and cardiac output. From these results, it is recommended that patients with tetralogy of Fallot and an EDVI of 30 ml/m2 or more can be considered as candidates for the primary repair, but that patients with an EDVI of less than 30 ml/m2 should be palliated once by systemic-to-pulmonary arterial shunt procedures. Subsequent total correction should be performed after sufficient LV growth for those patients.