日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 33(4): 335-340 (2017)
doi:10.9794/jspccs.33.335

症例報告Case Report

川崎病による冠動脈瘤を学校心臓検診で診断された2例Coronary Artery Aneurysms Caused by Kawasaki Disease Diagnosed at School Cardiac Screening in Two Children

久留米大学医学部小児科学教室Department of Pediatrics and Child Health, Kurume University School of Medicine ◇ Fukuoka, Japan

受付日:2017年3月17日Received: March 17, 2017
受理日:2017年6月15日Accepted: June 15, 2017
発行日:2017年7月1日Published: July 1, 2017
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我々は学校心臓検診時に初めて診断された冠動脈瘤を2例経験した.1例目は,他院で3歳時に川崎病急性期治療を受け,後遺症なしと診断されていた6歳男児で,学校心臓検診の2次検診で心エコー図検査を施行され,巨大冠動脈瘤と冠動脈狭窄を認め,ワーファリン定期内服と経皮的冠動脈形成術を必要とした.2例目は,9歳時に9日間発熱が持続し,他院で若年性特発性関節炎と診断され,加療された既往のある13歳男児であった.学校心臓検診の2次検診で心エコー図検査を施行したところ,中等度冠動脈瘤を発見した.アスピリン定期内服と当科外来での定期経過観察を行っている.

2例の冠動脈瘤とも川崎病の後遺症であり,急性期は発見されず,今回初めて診断に至ったものと考える.川崎病性冠動脈瘤の有無は治療方針や予後を大きく変えるため,心エコー図検査での冠動脈評価の精度を担保することと,学校心臓検診で原因不明の発熱が5日以上持続した既往者への心エコー図検査は重要であると考える.

We report two cases of coronary aneurysms that were not previously diagnosed during acute illness but were discovered for the first time during school cardiac screening (SCS).

Case 1 was a 6-year-old boy who had successful immunoglobulin treatment for typical Kawasaki disease (KD) at the age of 3. Though an echocardiographic examination during acute phase was reported as normal, echocardiography at SCS demonstrated giant left coronary aneurysms separated by coronary artery stenosis. Consequently, the patient was placed on oral warfarin and underwent percutaneous coronary angioplasty and coronary artery bypass surgery.

Case 2 was a 13-year-old boy who had a 9-day history of fever with several signs of KD and had been receiving treatment for juvenile idiopathic arthritis at 9 years of age. Though an echocardiographic examination at 9 day of the illness was reported as normal, echocardiography at SCS demonstrated a moderate sized left coronary artery aneurysm that was thought to be a sequela of incomplete KD. Consequently, the patient was administered oral aspirin and was regularly followed-up.

These cases illustrates that SCS may present an important opportunity to diagnose coronary aneurysm in patients with a history of complete or incomplete KD. As the presence of coronary aneurysms significantly alters treatment and prognosis, guidelines for echocardiography quality control and the proper timing of echocardiography in patients with incomplete KD are required.

Key words: school cardiac screening; Kawasaki disease; coronary artery aneurysm; echocardiography

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