Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A three-year-old girl with mitral regurgitation due to mucocutaneous lymph node syndrome (MCLS) but with normal coronary arteries was treated surgically. Although no definite pathologic lesions causing severe mitral regurgitation except for dilatation of the mitral annulus were found at operation, some minor changes implied focal ischemia of the posterior papillary muscle. A poster-medial annuloplasty was performed without significant residual regurgitation. This is the first patient successfully treated by surgery for mitral valve incompentence due to MCLS. However, additional clinical experiences will be needed to evaluate surgical treatment for this group patients.
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PMID:Mitral insufficiency secondary to mucocutaneous lymph node syndrome. A case report of successful surgical treatment. 71 29

Three American infants with Kawasaki disease (KD) complicated by peripheral extremity gangrene are reported. Eight such patients (only 1 from Japan) have been reported previously. These 11 patients, infants less than 7 months old at onset of KD, are predominantly non-Asian. At least nine had associated giant coronary aneurysms, and eight had associated peripheral arterial aneurysms. In eight infants the diagnosis of KD was not established and therapy was not instituted until greater than or equal to 14 days after onset. Peripheral ischemia initially was noted 15-31 days after onset. Although the pathogenesis of this complication is not well understood, it likely includes some combination of local peripheral arteritis, arteriospasm, thrombosis peripherally and/or more proximally (e.g., in an axillary artery aneurysm), and cardiogenic shock. Treatment may include use of antiinflammatory agents such as salicylates and intravenous gamma globulin, vasodilative agents and/or methods, and thrombolytic and/or anticoagulant agents in an attempt to prevent the potentially devastating consequences of progressive gangrene.
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PMID:Peripheral gangrene associated with Kawasaki disease. 157 15

Serial two-dimensional echocardiograms documented the formation of giant aneurysms, measuring from 0.55 to 3.1 cm in diameter, in the distribution of the left and right coronary arteries, in a 2 1/2-year-old boy with Kawasaki disease. His global left ventricular function, assessed by M-mode echocardiography, was normal, and no significant wall motion abnormalities could be detected on two-dimensinal evaluation. Cardiac catheterization showed multiple aneurysms with no evidence of stenosis. Although he had no clinical symptoms or electrocardiographic evidence of ischemia, pharmacologic stress and delayed Tl-201 SPECT images revealed prominent stress-induced myocardial ischemia in the left ventricle. A resting gated blood pool study showed hypokinesia in corresponding regions of the left ventricle. This case demonstrates the usefulness of Tl-201 myocardial SPECT imaging and resting gated blood pool studies in the management of coronary artery disease in children with Kawasaki disease.
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PMID:Noninvasive assessment of myocardium at risk by Tl-201 SPECT imaging in a child with Kawasaki disease. A case report. 161 89

The main cause of death in Kawasaki disease is myocardial infarction due to thrombotic occlusion of a coronary aneurysm. Intracoronary thrombolytic treatment was performed in 15 patients with Kawasaki disease with giant coronary aneurysms. Three patients had acute myocardial infarction, four demonstrated silent myocardial infarction, three suffered chest pain and five did not show ischemia features but had massive thrombus in the coronary aneurysms. Urokinase was infused into the coronary aneurysms as a bolus of 8,000 to 10,000 units/kg via a catheter over 10 minutes. Partial but significant coronary recanalization was achieved after injection of urokinase in a patient with acute myocardial infarction. Complete resolution of massive intracoronary thrombi was observed in 3 of 15 patents, and partial resolution was recognized in 4 cases. In 7 patients, the size of thrombus did not change. Recurrence of the thrombus was observed in 4 patients by serial two-dimensional echocardiography. Urokinase was readministered and two showed significant reduction in the thrombus. All patients have been followed for more than 2 years with longest 8 years (mean: 3.3 yrs), and none have had a recurrence of myocardial infarction or died. These findings suggest that intracoronary urokinase is useful for the treatment and prevention of myocardial infarction in Kawasaki disease.
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PMID:Intracoronary urokinase in Kawasaki disease: treatment and prevention of myocardial infarction. 185 11

The case of a 4-year-old boy with dipyridamole-induced ischemia is herein reported. The patient developed typical Kawasaki syndrome at 2 years of age, accompanied by coronary aneurysms in the left coronary artery (LCA) and the right coronary artery (RCA). The LCA was totally occluded at segment 6 and a distal area of the left anterior descending artery (LAD) was supplied by collaterals from the conus branch and the posterior descending artery (PD). Thallium-201 (Tl-201) myocardial scintigraphy was performed with intravenous administration of dipyridamole (DIP). DIP was infused at a dosage of 0.6 mg/kg for 5 min. Three minutes after the injection, myocardial ischemia occurred. Although 4 mg/kg of aminophylline was administered, the symptoms lasted for 20 min. Electrocardiogram suggested that ischemic lesions were located in the anteroseptal and inferior wall. Collaterals from PD could be recognized as jeopardized vessels and these collaterals probably participated in the ischemic attack. DIP could have increased the coronary flow into the uninvolved proximal branches of RCA. Subsequently DIP reduced coronary flow in the distal region of the stenotic RCA. Although T1-201 myocardial scintigraphy with DIP is a useful technique to estimate viability of the ischemic myocardium, it should be performed prudently in patients with multivessel diseases, such as those with jeopardized collaterals secondary to Kawasaki syndrome.
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PMID:Dipyridamole-induced ischemia in a child with jeopardized collaterals after Kawasaki syndrome. 208 82

We evaluated the validity of body surface mapping (MAP) in assessing noninvasively the degree of myocardial ischemia in patients with significant coronary arterial stenosis following Kawasaki disease. Delay of ventricular depolarization was examined by a departure map (DM) using mean QRS map, and the sensitivity of this method in detecting myocardial ischemia was evaluated based on the findings of coronary arteriography (CAG). The other noninvasive measures were also evaluated. MAP was obtained in 29 patients with significant coronary arterial stenotic lesions, including coronary occlusion, segmental stenosis and localized stenosis of 75% or greater. Mean QRS map was obtained based on MAPs in 41 children without organic heart disease and in 22 patients with significant stenotic lesions. The departure index (DIi) was calculated by subtracting potentials at each lead from those of the mean QRS maps and divided by the standard deviation. Departure area (Da) was defined as an area with DIi of -2 or less. Each MAP was subdivided into nine sections, and Da greater than or equal to one-eighth of the anterior wall section, Da greater than or equal to one-third of the posterior and inferior wall sections or Da greater than or equal to half of the other sections were regarded as ischemic areas. Sensitivity in detecting ischemia by MAP was assessed by the CAG findings, which was also compared to the sensitivity of the electrocardiograms (ECG), ECG with dipyridamole administration (Dp-ECG), vectorcardiograms (VCG), Holter ECG (Holter), treadmill test (TM), Master's double step test (MD), two-dimensional echocardiography (2DE) and thallium myocardial imaging (TMI).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Diagnosis of myocardial ischemia in patients with a significant coronary arterial stenosis following Kawasaki disease]. 213 52

This is the first report of re-aortocoronary bypass for Kawasaki's disease. The patient is a 22-year old female. She was afflicted with Kawasaki's disease at the age of 6 and had the symptom of angina pectoris at the age of 9. She went through the first aortocoronary bypass, to the left anterior descending artery (LAD) and the right coronary artery (RCA) with saphenous vein graft (SVG). After the first operation, the graft to LAD occluded totally, but she remained asymptomatic and well for 11 years. She had a sudden recurrence of anginal attack at the age of 20. The examinations confirmed ischemia of the anterior wall (LAD area) and the lateral wall (LCX area). Coronary angiography revealed patent SVG with a moderate sign of sclerotic change. We decided on re-aortocoronary bypass, left mammary artery to LAD and gastroepiploic artery to LCX, when she was 22-years old. LIMA was anastomosed to LAD, but LCX was not revascularized, because LCX was not identified and exposed in the operation. In spite of incomplete revascularization, postoperative stress ECG test was negative. Tl-myocardial scintigram confirmed no ischemia of the anterior wall and greatly reduced ischemia in the lateral wall. She became asymptomatic and returned to normal life.
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PMID:[A case report of redo A-C bypass for MCLS performed 13 years after initial surgery]. 226 33

To elucidate the incidence and natural history of valvular heart disease in Kawasaki syndrome, we analyzed patients who were found to have a new heart murmur after the onset of the disease. Among 1215 patients we found 13 (1.1%) with valvular disease (12 with mitral regurgitation and one with aortic regurgitation). We compared these patients with 30 who did not have valvular lesions. The duration of fever was longer and the incidence of coronary artery lesions significantly higher than in those without valvular disease. Heart murmurs disappeared within 2 months after the onset of valvular heart disease in five patients, whereas in another six, all involving valve prolapse, they persisted for 2 years or more. We postulate that two different mechanisms may be responsible for the variation in the duration of valvular heart disease: one, which disappeared spontaneously, was attributed to pancarditis; the other, which persisted, was due to dysfunction in valve and papillary muscles as a result of ischemia.
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PMID:Valvular heart disease in Kawasaki syndrome: incidence and natural history. 238 13

Cardiovascular complications (CVC) of Kawasaki disease (KD) are described in 15 affected children (10 boys, mean age 18.5 months). Clinical records, electrocardiographic tracings (ECG) and bidimensional echocardiograms (BDE) were analysed. In each case the first BDE was done at clinical diagnosis (mean time 10 days from initial symptoms of disease), then at weekly intervals for the first month and each two weeks along the second month. In children showing persistent coronary artery lesions (CAL) BDE was repeated monthly and in patients without CVC at three month intervals. During follow up, no definite clinical evidence of miocardial ischemia was found, but abnormal BDE recordings were obtained from 12/15 patient: CAL in 9/15; right ventricular, left ventricular and aortic enlargement in 3/15. CAL were located at the left coronary artery (LCA) in 3/9 (one LCA aneurysm) and at both coronary arteries in 6/9 (including 3 cases with bilateral aneurysms). All patients were given aspirin and seven were also treated with intravenous gammaglobulin, this last at day 9 (mean) of disease, but 5 of them developed CVC, including 3 cases of CAL.
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PMID:[Cardiac involvement in Kawasaki disease]. 252 Aug 36

Acute hydrops of the gall bladder has been reported in Kawasaki syndrome (KS) (Mucocutaneous lymph node syndrome/MCLS) as a major component of abdominal crises. We report 2 cases of KS where hydrops of the gall bladder was not associated with abdominal pain and was diagnosed by ultrasonography. In additional, one of these cases had ischemia involving the penoscrotal region secondary to vascular involvement.
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PMID:Hydrops of the gall bladder associated with Kawasaki syndrome. 267 98


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