[Application of selective coronary angiography in children with Kawasaki disease complicated with severe coronary artery lesion].

Objective: To investigate the application of coronary angiography (CAG) in children with Kawasaki disease complicated with coronary artery lesion (CAL). Methods: A total of 139 patients (115 boys and 24 girls, age (48±42) months) with Kawasaki disease complicated with CAL underwent CAG between June 2006 and June 2018 in Children's Hospital of Fudan University. CAL in all children were at grade Ⅲ and above assessed by echocardiography and underwent CAG under general anesthesia with parental consent. A retrospective analysis was performed to identify the safety and complication of CAG, degree of satisfaction of image, distribution of CAL, and the treatment and follow-up management according to the result of CAG. Results: All the 139 patients underwent CAG, and 17 patients received CAG twice. In these cases, there was a total of 309 CAL with an average of 2.22 CAL per patient. After CAG, children were re-graded as grade Ⅲ in 33 cases, grade Ⅳ in 56 cases, grade Ⅴa in 33 cases and grade Ⅴb in 17 cases according to the clinical severity. Ten patients (7.2%) had only aortic root angiography and 129 (92.8%) patients had selective left or right CAG. Among these, 27 cases (19.4%) showed thrombosis in coronary aneurysm, 23 cases (16.5%) showed coronary artery stenosis, 4 cases (2.9%) showed recanalization after occlusion in right coronary artery. All the patients obtained satisfied images, and no complication was found. Eight of the grade Ⅴb patients underwent coronary artery bypass grafting (CABG). One patient died during the surgery due to severe heart failure, and the other seven patients received CABG successfully and recovered well during a long-term follow up (18 to 108 months). Conclusions: CAG is safe for children with Kawasaki disease with CAL, and the images of CAG are satisfied. Patients who were graded according to CAG and received the corresponding surgical treatment could get satisfied effect in the medium and long-term follow-up.