Coronary Angiography of Kawasaki Disease with the Coronary Vasodilator Dipyridamole: Assessment of Distensibility of Affected Coronary Arterial Wall

Abstract

The authors evaluated the disten sibility of the coronary arterial wall by pharmacoangiography with intra venous administration of dipyrida mole in 38 patients with Kawasaki disease. In the acute stage of the ill ness, the coronary arteries were eval uated for aneurysms by two-dimen sional echocardiography. After the acute stage of the illness, selective coronary cineangiographies were performed by Seldinger's method un der general anesthesia before and af ter intravenous administration of 0.6 mg/kg of dipyridamole for four min utes. The calibers of aneurysms and normal appearing segments of coro nary arteries, at most 7 segments in 1 patient, were measured before and after dipyridamole administration on the high-quality cineangioanalyzer and percentages of coronary arterial dilatation were calculated. In 14 cases without evidence of coronary arterial lesions, the distensibility was 10.2 ± 4.7% (mean±SD) . The disten sibility of 32 aneurysms in 16 cases was 0.6 ± 1.1% and was significantly decreased (p < 0.001). In 24 cases with coronary arterial lesions, aneu rysms, stenosis, or obstruction, the distensibility of normal appearing segments of coronary arteries was 4.5 ± 4.9% and was significantly de creased (p < 0.001). This method is useful in evaluating distensibility and appears to be effective in detecting pathologic changes of the coronary arterial wall, even if it appears nor mal in shape. The patient with previ ously diseased coronary arteries should be kept under careful long- term surveillance.