Coronary Angiographic Findings of Left Atrial Thrombi in Mitral Stenosis

PURPOSE: To investigate the coronary angiographic findings of left atrial thrombi associated with mitral stenosis. MATERIALS AND METHODS: In 98 patients who had undergone coronary angiography and in whom the presence of left atrial thrombi was confirmed by surgery or repeated transesophageal echocardiography, evaluated the pattern, origin and location of abnormal vasculature suggestive of left atrial thrombi such; abnormalities included neovascularity, staining, dye collection and fistula. RESULTS: Abnormal vasculature was observed in 70 patients (71.4%). It arose from the left circumflex artery in 66 patients (including the sinus nodal branch in four), the right coronary artery in 14 (including the sinus nodal branch in 7 and conal branch in 2), the left anterior descending artery in one, and the left main coronary artery in one. The patterns of abnormal vasculature arising from the left coronary artery were fistula in 50, dye collection in 32, staining in 29 and neovascularity in 24; those arising from the right coronary artery were fistula in four, dye collection in two, staining in four and neovascularity in nine. Abnormal vasculature located at the anterior third of the left atrium in 50 cases, the middle in 20, and the posterior region in 12. CONCLUSION: The abnormal vasculature suggested by left atrial thrombi most commonly arose from the left circumflex artery and was located at the anterior one-third of the left atrial cavity. Fistula was the most common finding of left atrial thrombi, and for that these detection of the abnormal vasculature thrombi give rise to, selective coronary angiography was the useful modality.

Angiographic Evaluation of Coronary Arterial Abnormalities in Kawasaki Disease

PURPOSE: To evaluate the coronary angiographic findings of patients with Kawasaki disease and to investigatethe natural course of aneurysms of the coronary artery. MATERIALS AND METHODS: Between June 1989 and January1996, we evaluated the coronary angiographic findings of 12 consecutive children with Kawasaki disease whosecoronary artery was abnormal. On initial study, we retrospectively analysed the size, configuration, and locationof 35 coronary aneurysms, and in five children, follow-up coronary angiography was performed at intervals of 17 to28 (mean, 23) months. Seventeen aneurysms detected on initial study were evaluated for subsequent change. RESULTS: Initial coronary angiography showed the aneurysms to be diffuse in 7 cases(20%), saccular in 7(20%), fusiform in17(49%), and tubular in 4(11%). They were large in 10 cases (29%), medium in 22(63%), and small in 3(9%) ; theirlocation in the coronary artery was proximal(71%), middle in 6(17%), and distal in 4(11%). The right coronaryartery was involved in 18 case(51%), and the left coronary artery in 17(49%). Follow-up study showed that theaneurysm had regressed in 11 cases (65%), persisted in 2(12%), and progressed to stenosis in 1(6%) and occlusionin 3(18%). Two(50%) of the four large aneurysms showed complete occlusion. On the other hand, medium and smallaneurysms showed regression in 9(82%) and in all cases, respectively. Diffuse-type aneurysms were complicated byocclusion in 2 cases (50%) and stenosis in 1(25%). On the other hand, six fusiform aneurysms (75%) and allsaccular and tubular aneurysms had regressed. CONCLUSION: In patients with kawasaki disease, informationregarding the size and configuration of coronary aneurysms may be useful for predicting the natural course andprognosis of coronary artery disease.