A Research On The Clinical Application Value Of Transthoracic Echocardiography In Evaluating The Coronary Artery Lesions In Kawasaki Disease

Objective To study the inner diameter,shape and thrombosis situation of the coronary artery in pediatric patients with Kawasaki disease(KD)before treatment and post-treatment follow-up using transthoracic echocardiography(TTE),and to explore the value of TTE on the diagnosis,therapy and follow-up of coronary artery lesions caused by KD.Methods The clinical data and TTE results of totally 303 cases of pediatric patients diagnosed with KD from pediatrics department of The First Affiliated Hospital of Guangxi Medical University from January 2012 to June 2017 were retrospectively analyzed.(1)the age,height,body weight,days of fever when visiting and hospitalization diagnosis of each patient were collected;(2)each of the TTE measurement indexes of the inner diameter of the left main coronary artery(LMCA),the inner diameter of the left anterior descending branch(LAD),the inner diameter of the left circumflex branch(LCX),the inner diameter of the right coronary artery(RCA),the inner diameter of the aortic root(AO),the size of the coronary artery aneurysms(CAA),size and shape of the coronary artery thrombosis(CAT),left ventricular ejection fraction(LVEF),ventricular wall contractive activity situation of all the pediatric patients before treatment and post-treatment follow-up in 2 years were collected;(3)the 303 cases of pediatric patients with KD were divided into typical KD group(214 cases)and incomplete Kawasaki disease(IKD)group(89 cases)according to clinical diagnosis;and then divided into age ? 1 year group(94 cases)and age > 1 year group(209 cases)according to the age;(4)The coronary artery lesions clinical classification used the criteria proposed by Wangxinfang,etc,and were divided into four levels,normal,coronary artery dilatation,coronary artery aneurysm,giant aneurysm;(5)The pediatric patients with CAA formation were analyzed by LMCA,LAD,LCX and RCA.Results 1.The incidence rate of coronary artery lesions pediatric patients with KD reached up to 88.8%,which was mainly coronary artery dilatation.2.The recovery rate of pediatric patients with coronary artery dilatation was high(72.7%),most of them returned to normal within 3 months after treatment.3.During the follow-up process of pediatric patients with CAA,each branch with CAA or coronary artery dilatation showed retraction trend(71.4%),about 45.7% recovered completely within 2 years.4.There are statisitical differences in recovery situation and thrombosis rates between giant CAA and moderate CAA(P(27)0.05).5.Compared with the pediatric patients with topical KD,the IKD pediatric patients had longer fever course,higher coronary artery lesions incidence rate and higher incidence rate of coronary artery dilatation(P(27)0.05),but the recovery rate of coronary artery dilatation in pediatric patients with topical KD was higher than that of IKD pediatric patients(P(27)0.05).6.Compared with the pediatric patients in the group of age > 1 year,the pediatric patients in the age ? 1 year group had longer fever course,higher coronary artery lesions incidence rate and higher incidence rate of coronary artery dilatation(P(27)0.05).Conclusion 1.The incidence rate of coronary artery lesions in KD was higher and most of the coronary artery lesions could be recovered after treatment,the recovery of coronary artery dilatation was rapid,but the recovery time of CAA was longer.2.The giant CAA was harder to recover compared with the moderate CAA,and was easier to form thrombus.3.The IKD pediatric patients and the pediatric patients in infant period were the vulnerable population of coronary artery lesions.4.The TTE has important clinical significance in diagnosis,treatment,prognosis and long-term follow-up of KD associated with coronary artery lesions.