Advertisement

Pediatric Cardiology

, Volume 25, Issue 2, pp 108–112 | Cite as

Myocardial Blood Flow and Coronary Flow Reserve in Children with “Normal” Epicardial Coronary Arteries After the Onset of Kawasaki Disease Assessed by Positron Emission Tomography

  • M. HauserEmail author
  • F. Bengel
  • A. Kuehn
  • S. Nekolla
  • H. Kaemmerer
  • M. Schwaiger
  • J. Hess
Original Article

Abstract

Myocardial blood flow (MBF) was investigated in children (14.2 ± 5.01 years) with “resolved” coronary involvement after the onset of Kawasaki disease and angiographically normal epicardial coronary arteries. Ten asymptomatic children with a history of Kawasaki disease had electrocardiography, echocardiography, and positron emission tomography (PET) 10.3 ± 6.01 years after onset of the acute illness. Myocardial perfusion was assessed by NH3− PET at rest and after vasodilatation and compared with that of 10 healthy volunteers (26.1 ± 6.3 years). No patient had signs of myocardial ischemia; on echocardiography ventricular function was normal without dyskinetic areas or signs of enlargement or stenosis of the proximal coronary arteries. There was no statistical significant difference between patients and volunteers in MBF at rest (0.86 ± 0.27 vs 0.77 ± 0.17 ml/g/min), whereas MBF after vasodilatation (2.42 ± 0.81 vs 3.10 ± 0.8 ml/g/min) and coronary flow reserve (CFR) (2.89 ± 0.26 vs 4.09 ± 1.01 mmHg/ml/g/min) were significantly attenuated in the Kawasaki group. No stress-induced perfusion defects could be detected. In children with a history of Kawasaki disease and angiographically normal epicardial coronary arteries, there is a significant attenuation of MBF after vasodilatation and a significant reduction of CFR. Impairment of vasoreactive ability may indicate residual damage of the coronary arteries and may be a risk factor for atherosclerosis in adulthood.

Keywords

Kawasaki disease Coronary arteries Myocardial blood flow Position emission tomography Atherosclerosis 

References

  1. 1.
    Batchelor, S, Blake, GM, Saunders, JE 1992A comparison of three commercially available PET imaging systems.Nucl Med Commun132027Google Scholar
  2. 2.
    Czernin, J, Muller, P, Chan, S 1993Influence of age and hemodynamics on myocardial blood flow and flow reserve.Circulation886269PubMedGoogle Scholar
  3. 3.
    Fujiwara, T, Fujiwara, H, Nakano, H 1988Pathological features of coronary arteries in children with Kawasaki disease in which coronary arterial aneurysm was absent at autopsy.Circulation78345350Google Scholar
  4. 4.
    Furuyama, H, Odagawa, Y, Katoh, C,  et al. 2002Assessment of coronary function in children with a history of Kawasaki disease using O-water positron emission tomography.Circulation10528782884Google Scholar
  5. 5.
    Hamaoka, K, Onouchi, Z, Kamiya, Y 1991Coronary sinus blood flow and coronary haemodynamic function in children: measurement by the continuous thermodilution method with coronary sinus cannulation via the femoral vein.Br Heart J65171173PubMedGoogle Scholar
  6. 6.
    Hamaoka, K, Onouchi, Z, Ohmochi, Y 1992Coronary flow reserve in children with Kawasaki disease without angiographic evidence of coronary stenosis.Am J Cardiol69691692PubMedGoogle Scholar
  7. 7.
    Hijazi, ZM, Udelson, JE, Snapper, H 1994Physiologic significance of chronic coronary aneurysms in patients with Kawasaki disease.J Am Coll Cardiol2416331638PubMedGoogle Scholar
  8. 8.
    Hutchins, GD, Schwaiger, M, Rosenspire, KC,  et al. 1990Non-invasive quantification of regional myocardial blood flow in the human heart using N-13 ammonia and dynamic positron emission tomography imaging.J Am Coll Cardiol1510321104213Google Scholar
  9. 9.
    Iemura, M, Ishii, T, Sugimura, T 2000Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function.Heart83307311Google Scholar
  10. 10.
    Ishiwata, S, Fuse, K, Nishiyama, S,  et al. 1992Adult coronary artery disease secondary to Kawasaki disease in childhood.Am J Cardiol69692694PubMedGoogle Scholar
  11. 11.
    Kato, H, Ichinose, E, Kawasaki, T 1986Myocardial infarction in Kawasaki disease: clinical analysis in 195 cases.J Pediatr108923927PubMedGoogle Scholar
  12. 12.
    Kato, H, Inoue, O, Kawasaki, T,  et al. 1992Adult coronary artery disease probably due to childhood Kawasaki disease.Lancet34011271129CrossRefPubMedGoogle Scholar
  13. 13.
    Kato, H, Ichinose, E, Yoshioka, F 1982Fate of coronary aneurysm in Kawasaki disease: serial coronary angiography and long-term follow-up.Am J Cardiol4917581766PubMedGoogle Scholar
  14. 14.
    Mitani, Y, Okuda, Y, Shimpo, H 1997Impaired endothelial function in epicardial coronary arteries after Kawasaki disease.Circulation96454461Google Scholar
  15. 15.
    Muzik, O, Beanlands, RS, Hutchins, GD,  et al. 1993Validation of nitrogen 13-ammonia tracer kinetic model for quantification of myocardial blood flow using PET.J Nucl Med34831891Google Scholar
  16. 16.
    Muzik, O, Paridon, SM, Singh, TP,  et al. 1996Quantification of myocardial blood flow and flow reserve in children with a history of Kawasaki disease and normal coronary arteries using positron emission tomography.J Am Coll Cardiol28757762CrossRefPubMedGoogle Scholar
  17. 17.
    Newburger, J, Takahashi, M, Beiser, A 1991A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome.N Engl J Med32416331639PubMedGoogle Scholar
  18. 18.
    Pahl, E, Ettedgui, J, Neches, WH, Park, SC 1989The value of angiography in the follow-up of coronary involvement in mucocutaneous lymph node syndrome (Kawasaki disease)J Am Coll Cardiol1413181325PubMedGoogle Scholar
  19. 19.
    Paridon, SM, Galioto, FM, Vincent, JA,  et al. 1995Exercise capacity and incidence of myocardial perfusion defects after Kawasaki disease in children and adolescents.J Am Coll Cardiol2514201424CrossRefPubMedGoogle Scholar
  20. 20.
    Ross, BA 1995Kawasaki disease: unsafe at any age?J Am Coll Cardiol2514251427CrossRefPubMedGoogle Scholar
  21. 21.
    Suzuki, A, Miyagawa-Tomita, S, Komatsu, K 2000Actice remodeling of the coronary artery lesions in the late phase of Kawasaki disease: immunohistochemical study.Circulation10119351941Google Scholar
  22. 22.
    Suzuki, A, Yamagishi, M, Kimura, K 1996Functional behaviour and morphology of the coronary artery wall in patients with Kawasaki disease assessed by intravascular ultrasound.J Am Coll Cardiol27291296CrossRefPubMedGoogle Scholar
  23. 23.
    Young, DF, Tsai, FY 1973Flow characteristics in models of arterial stenoses-steady flow.J Biomechanics6395410Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • M. Hauser
    • 1
    Email author
  • F. Bengel
    • 2
  • A. Kuehn
    • 1
  • S. Nekolla
    • 2
  • H. Kaemmerer
    • 1
  • M. Schwaiger
    • 2
  • J. Hess
    • 1
  1. 1.Department of Paediatric CardiologyDeutsches Herzzentrum, Lazarettstraße 36, 80636 MunichGermany
  2. 2.Nuklearmcdizinische Klinik der TU, Ismaningerstrasse 22, 81675 MunichGermany

Personalised recommendations