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In vivo visualization of braid-like appearance in Kawasaki disease: insights from multi-modality imaging
Hiroki Nakano1, Yu Kataoka2, Satoshi Yasuda1
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka, 565-8565, Japan.
Insights
Kawasaki disease can cause silent cardiac ischemia due to unique "braid-like" coronary artery lesions. Optical coherence tomography uniquely identified micro-vessels within these lesions, revealing potential causes of reduced blood flow.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Pediatric Cardiology
Background:
- Kawasaki disease is a leading cause of acquired pediatric heart disease.
- Silent myocardial ischemia can occur in patients with Kawasaki disease.
- Coronary artery abnormalities are a known complication of Kawasaki disease.
Observation:
- A 42-year-old gentleman with a history of Kawasaki disease presented with silent inferior myocardial ischemia.
- Coronary angiography revealed a distinctive "braid-like" appearance in the right coronary artery.
- Multi-slice computed tomography and intravascular ultrasound visualized multiple channels within the braid-like segment.
Findings:
- Optical coherence tomography (OCT) uniquely identified numerous micro-vessels within the braid-like lesion.
- These micro-vessels were not discernible with other imaging modalities.
- The morphological features of the braid-like lesion suggest a potential impact on coronary blood supply.
Implications:
- This case highlights the distinct morphology of braid-like coronary lesions in Kawasaki disease.
- Advanced imaging like OCT is crucial for detailed characterization of complex coronary lesions.
- Understanding these intricate vascular structures is vital for diagnosing and managing cardiac ischemia in affected patients.
Abstract:
A 42-year-old gentleman with Kawasaki disease was referred for silent cardiac ischemia at inferior myocardial region. Coronary angiography showed braid-like appearance in the right coronary artery. Several channels at the segment with braid-like appearance were visualized by multi-slice computed tomography and intravascular ultrasound. Interestingly in particular, optical coherence tomography visualized the presence of multiple micro-vessels which were not detectable on other modalities. This case further elucidates distinct morphological features of braid-like lesion which potentially influences blood supply and causing cardiac ischemia.
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