小児期冠動脈病変—小児期に選択的冠動脈造撮が必要な疾患についての検討

Coronary heart diseases in infancy:Studies on various heart diseases requiring selective coronary arteriography in infants and children

はじめに

　従来より小児の冠動脈疾患は比較的稀とされており，内外ともに系統的な報告は数少ない。しかし近年，乳幼児期に好発する川崎病（Mucocutaneous lymphnode Syn—drome；　MCLS）の心臓後遺症として10〜20％に冠動脈病変の合併をみる^1）ことが知られるようになってから小児循環器専門医にとって小児の選択的冠動脈造影（Sele—ctive coronary arteriography；S-CAG）の技術は必要不可欠のものとなった感がある。

　今回著者らは川崎病も含め最近扱った冠動脈疾患例をまとめ若干の考察を加えたので報告する。

There has been a few reports of coronary arterial diseases and anomalies in infants and children. But as selective coronary arteriography (S-CAG) has become routine technique to evaluate coronary ar-terial complications following Mucocutaneous Lym-phnodc Syndrome (MCLS), it has been known that coronary arterial disease occur more frequently than commonly believed in infants and children.

We performed S-CAG in ninety infants and Chil-dren, two months to fifteen years old sixty two boys and twenty eight girls).

Twenty eight of ninety patients had coronary arterial diseases, which were Bland-White-Garland Syndrome, single coronary artery, coronary artery fistula, coronary aneurysm and so on.

In cyanotic congenital heart disease there was high incidence of coronary artery anomalies, fourty two percent of cyanotic congenital heart disease in our cases. Therefore it is considered that S-CAG should be performed in cyanotic congenital heart disease as routine work.

In noncyanotic congenital heart disease the coro-nary arteries should be carefully evaluated in chil-dren with supravalvar valvar, subvalvar stenosis, which are known that congenital coronary anoma-lies are associated with.

With recent advances in cardiac surgical tech-nique, many of congenital coronary anomalies are amenable to surgery that requires accurate anato-mic delineation by S-CAG.

Coronary arteriography is associated with compli-cations, but there was no serious complications in our cases.

S-CAG is now considered safe and valuable meth-od even in young infants, especially in infants and children with MCLS.