Silent myocardial ischemia in Kawasaki disease: evaluation of percutaneous transluminal coronary angioplasty by dobutamine stress testing.
BACKGROUND
Myocardial ischemia and myocardial infarction are the most serious complications of coronary artery lesions in children with Kawasaki disease (KD). Therefore, early detection and treatment of myocardial ischemia in patients with KD is essential. We studied the effectiveness of percutaneous transluminal coronary angioplasty (PTCA) in patients with silent myocardial ischemia detected by dobutamine stress 99mTc myocardial scintigraphy (TMS), body surface mapping (BMS), and signal-averaged ECG late potentials (ELP).


RESULTS
Eight of 76 asymptomatic patients with a coronary stenosis >25% and a positive dobutamine stress test were considered to have silent myocardial ischemia. All eight patients had >95% stenoses demonstrated by coronary angiography (CAG) just before PTCA. After PTCA, CAG showed that all of the coronary artery stenoses had been reduced to <50%. Additionally, intravascular ultrasonography (IVUS) performed in five patients before and after PTCA demonstrated adequate dilation of the coronary stenosis after PTCA. All eight patients underwent dobutamine stress TMS, BMS, and ELP 2 to 3 months after PTCA, which demonstrated no regions of myocardial ischemia. Approximately 6 months later, CAG was performed in all eight patients, and only one patient had developed restenosis.


CONCLUSIONS
PTCA effectively dilates stenotic coronary arteries in children with KD. Moreover, dobutamine stress TMS, BMS, and ELP are useful for detecting silent myocardial ischemia and estimating the effectiveness of PTCA. Furthermore, IVUS is useful for evaluating the severity of coronary artery lesions before and after PTCA in patients with KD.
Ogawa
S
S
Department of Pediatrics, Nippon Medical School Hospital, Tokyo, Japan. boston@nms.ac.jp
Fukazawa
R
R
Ohkubo
T
T
Zhang
J
J
Takechi
N
N
Kuramochi
Y
Y
Hino
Y
Y
Jimbo
O
O
Katsube
Y
Y
Kamisago
M
M
Genma
Y
Y
Yamamoto
M
M
D000293:Adolescent; D015906:Angioplasty, Balloon, Coronary; D018780:Body Surface Potential Mapping; D002316:Cardiotonic Agents; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D004280:Dobutamine; D004562:Electrocardiography; D005069:Evaluation Studies as Topic; D005080:Exercise Test; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon; D018084:Ultrasonography, Interventional
D002316:Cardiotonic Agents; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D004280:Dobutamine; C078700:technetium tc-99m tetrofosmin