Page 27 - Journal of Structural Heart Disease Volume 2, Issue 5

Case Report
228
Figure 3. Selective coronary angiography of the right coronary artery (RCA) after complete revascularization Panel A. Frontal view. Panel B. Lateral view. The RCA shows two gigantic aneu- rysms measuring more than 6 mm in diameter. After dilatation mild stenosis at the exits of the aneurysms persists.
cases from Japan and other Asian countries. Throm- bolytic agents such as urokinase and rT-PA have been used to treat acute myocardial ischemia secondary to
Figure 4. Levels of troponin I after revascularization of the right coronary artery.
thrombus formation in CAAs of patients with KD [5, 10, 14]. Improved outcome was reported when the agents were administered directly into the coronary arteries [5, 15]. Ariyoshi et al. [4] reported three cases, in patients aged 20–35 years, in whom primary percu- taneous coronary interventions in combination with intracoronary thrombolysis proved to be safe and ef- fective in acute myocardial infarction. Karia et al. [14] reported a 29-day-old child with KD who presented with multiple medium-size CAAs as well as coronary thromboses, myocardial ischemia, and congestive heart failure. The infant successfully underwent intra- coronary infusion of rT-PA. He had a history of KD at the age of 8 days. Mongiovi et al. [16] reported a 7-year-old boy with acute myocardial infarction in whom primary recanalization with angioplasty and complete reperfusion of the occluded artery was achieved. At 2-year follow up, ventricular function was still normal. Inaba used pulse infusion of throm- bolysis (rT-PA) into the thrombus in a 24-year-old man with complete distal thrombosis of the RCA [15].
Interventional treatment in addition to thromboly- sis was described in some other studies. Akagi et al. [3] reported the results of a nationwide review of 55 institutions in Japan: In 57 patients, percutaneous transluminal angioplasty (PTCA) was performed in 34, percutaneous transluminal coronary rotational abla- tion (PTCRA) in 13, directional coronary atherectomy (DCA) in 4, and stent implantation in 7. The success rate was 74% for PTCA, 100% for PTCRA, 100% for DCA, and 86% for stents. Ishii et al. [13] reported a
Journal of Structural Heart Disease, October 2016
Volume 2, Issue 5:224-230