Transthoracic Doppler assessment of coronary flow velocity reserve in children with Kawasaki disease
Comparison with coronary angiography and thallium-201 imaging
Satoshi Hiraishi, MD*,*,
Hamao Hirota, MD*,
Yasunori Horiguchi, MD*,
Nobuhiro Takeda, MD*,
Nobuyuki Fujino, MD*,
Natsuko Ogawa, MD* and
Yayoi Nakahata, MD*
* Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
View larger version (59K):
[in a new window]
|
Figure 1 (A) Transthoracic color Doppler flow mapping in the posterior descending artery (PD) at rest in a patient with a normal right coronary artery (RCA). Note the position (arrowhead) of the distal RCA within the posterior atrioventricular groove. The PD (red-coded blood flow) courses toward the apex within the posterior interventricular sulcus and the middle cardiac vein (MC) is simultaneously imaged with blue-coded blood flow next to the PD. (B) Transthoracic color Doppler flow mapping in the distal left anterior descending coronary artery (LAD) at rest in a patient with a normal left coronary artery. The LAD (red-coded blood flow) courses toward the apex within the anterior interventricular sulcus. A = anterior; I = inferior; L = left; LV = left ventricle; P = posterior; R = right; S = superior.
|
|
View larger version (108K):
[in a new window]
|
Figure 2 (Upper left panel) Selective right coronary angiogram demonstrating multiple aneurysms in a 16-year-old patient. (Upper middle and right panels) Intracoronary Doppler flow wire tracings in the posterior descending artery (PD) at rest (middle) and after adenosine triphosphate infusion (right). (Lower panels) In the same patients, transthoracic Doppler flow tracing are shown in the PD at rest and after dipyridamole infusion.
|
|
View larger version (14K):
[in a new window]
|
Figure 3 (Left panel) Relationship between mean coronary flow velocity reserve (CFVR) obtained using the transthoracic and intracoronary Doppler methods. (Right panel) Plot of the difference between CFVRs obtained using the two aforementioned methods against their average. Open circles = CFVR measurements in the distal right coronary artery and posterior descending artery; closed circles = CFVR measurements in the left anterior descending coronary artery.
|
|
View larger version (105K):
[in a new window]
|
Figure 4 Transthoracic spectral Doppler flow velocity curves at rest and during hyperemia in the left anterior descending coronary artery before (upper panels) and one day after angioplasty by rotablation (lower panels) in a 19-year-old patient with 95% stenosis at both sites just proximal and distal to the aneurysm. Peak coronary flow velocity reserve increased from 1.1 to 2.0.
|
|
View larger version (127K):
[in a new window]
|
Figure 5 Intracoronary Doppler flow wire tracing at rest and during hyperemia in the left anterior descending coronary artery before (upper panels) and just after (lower panels) angioplasty by rotablation in the same patient as shown in Figure 4. Peak coronary flow velocity reserve increased from 1.3 to 2.0.
|
|
|
