Serial intracoronary ultrasound in children: feasibility, reproducibility, limitations, and safety.
Pediatric patients with heart transplants and Kawasaki disease are at risk to develop coronary artery disease. Selective coronary angiography underestimates vasculopathy in transplant patients and intimal changes in Kawasaki disease. Routine intracoronary ultrasound imaging in adults accurately identifies histopathologic features not visualized by angiography. Little data are available regarding safety and efficacy in children. This study provides sequential data and experience in children between the ages of 2 1/2 and 22 years. Thirty-two patients underwent 62 intracoronary ultrasound examinations at the time of coronary angiography. Careful correlation of the ultrasound crystal locations with the angiographic images of the vessels was made. Images were analyzed for intimal hyperplasia and luminal diameters. Intracoronary ultrasound was more sensitive than angiography in detecting vessel wall disease. Coronary vasospasm occurred in 11 of 62 studies after the intracoronary ultrasound study. All but 1 episode were asymptomatic and resolved after intracoronary nitroglycerine. When a standard protocol is followed and current technology is used, intracoronary ultrasound is feasible, reproducible, efficacious, and safe in the young patient. It allows earlier detection of vasculopathy and intimal disease at angiographically normal sites. As technology improves and greater experience is gained, the long-term safety and prognostic value of these studies in children should be forthcoming.
Schratz
Lorraine Marasco
LM
Division of Pediatric Cardiology, Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Meyer
Richard A
RA
Schwartz
David C
DC
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D012449:Safety; D018084:Ultrasonography, Interventional / Q000379:methods*