Estimation of myocardial hemodynamics before and after intervention in children with kawasaki disease
Shunichi Ogawa, MD*,*,
Takashi Ohkubo, MD*,
Ryuji Fukazawa, MD*,
Mitsuhiro Kamisago, MD*,
Yukio Kuramochi, MD*,
Yohko Uchikoba, MD*,
Ei Ikegami, MD*,
Miki Watanabe, MD* and
Yasuhiro Katsube, MD*
* Department of Pediatrics, Nippon Medical School Hospital, Tokyo, Japan
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Figure 1 Coronary average peak flow velocities at rest and after hyperemia in a 10-year-old boy. He had 95% coronary stenosis in segment 2 and infero-posterior myocardial ischemia. The averaged peak velocities at rest (A) and after hyperemia (B) were equal (11 cm/s), and coronary flow reserve was 1.0.
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Figure 2 Intra-coronary pressure and coronary fractional flow reserve in a 6-year-old boy. There were two aneurysms at segments 5 and 6 and 90% stenosis between the aneurysms and myocardial ischemia in the antero-septal region. A guiding catheter was advanced into the ostium of the coronary artery, and pressure was then measured (Pa). To measure Pd, we used a 0.014-inch pressure monitoring wire. The wire was advanced into the coronary artery, positioned across the stenotic lesion, to measure intra-coronary pressure (Pd). After these pressure measurements had stabilized, maximum coronary hyperemia was induced by intravenous infusion of papaverine hydrochloride. In this case, myocardial fractional flow reserve (FFRmyo) was calculated from simultaneously recorded values of Pa, Pd, and Pv (mean right atrial pressure) at steady-state maximum hyperemia. The Pd, Pa, and Pv values were 3 mm Hg, 45 mm Hg, and 68 mm Hg, and FFRmyo was 0.65.
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Figure 3 The coronary flow reserve (CFR) values in different coronary arteries in each branch. The error bar shows 1 SD from the mean value. *p < 0.05 vs. other branches in the N and D groups.
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Figure 4 The myocardial fractional flow reserve (FFRmyo) values in different coronary arteries in each branch. *p < 0.05 vs. other branches in the N and D groups. D = abnormal coronary artery without ischemia group; IS = ischemia group; LAD = left anterior descending artery; LCX = left circumflex artery; N = normal coronary group; RCA = right coronary artery.
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Figure 5 These averaged peak velocities and coronary flow reserves are of the same patient as in Figure 1 after plain old balloon angioplasty, which was done with a 3.0-mm-diameter balloon catheter at 10 atm twice. After plain old balloon angioplasty, there was no significant stenosis on coronary angiography (A), and coronary flow reserve turned to normal (2.3) (B, C). Moreover, the flow pattern changed from a disturbed pattern to a pulsatile pattern.
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Figure 6 Intra-coronary pressures and myocardial fractional flow reserve of the same patient as in Figure 2 after coronary artery bypass graft. About six months after coronary artery bypass graft, coronary angiography showed no stenosis at anastomosis of the left intra-thoracic artery and left anterior descending artery. The myocardial fractional flow reserve turned to normal (0.96).
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