title: Calcified occlusion of the right coronary artery in Kawasaki disease: evidence of myocardial ischaemia using cardiac technetium-99m-tetrofosmin perfusion single-photon emission computed tomography.
abstract: We report the case of a 14-year-old boy who developed Kawasaki disease at 5 months of age. The patient developed severe aneurysmal disease of both the left and right coronary arteries. He eventually developed total calcified occlusion of the right coronary artery despite long-term treatment with aspirin. Catheterisation showed no antegrade flow into the right coronary artery, with retrograde flow from the left coronary system into the right coronary. At the most recent follow-up he was asymptomatic, with normal exercise tolerance and a negative exercise stress test. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging was carried out during stress and at rest using intravenous persantine (dipyridamole) and technetium-99m tetrofosmin. During stress, there were prominent left ventricular apical and anteroseptal defects, which normalised at rest. SPECT during stress and at rest may detect subclinical ischaemia and influence further management options in such patients.
authors.affiliation: Department of Paediatric Cardiology, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Beamish
authors.forename: M J
authors.initials: MJ
authors.lastname: O'Connell
authors.forename: A
authors.initials: A
authors.lastname: El Khuffash
authors.forename: D F
authors.initials: DF
authors.lastname: Duff
authors.forename: C J
authors.initials: CJ
authors.lastname: McMahon
mesh_terms: D000293:Adolescent; D002113:Calcification, Physiologic; D000077144:Clopidogrel; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D025401:Echocardiography, Stress; D005080:Exercise Test; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019275:Radiopharmaceuticals; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging*
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D010975:Platelet Aggregation Inhibitors; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin; D000077144:Clopidogrel; D013988:Ticlopidine