背景:巨大冠状动脉瘤引起的冠状动脉血栓形成和心肌缺血是川崎病患儿死亡的主要原因。在患有冠状动脉血栓的川崎病儿童中使用溶栓治疗是一个有争议的话题,尤其是治疗的时机。
方法:在本文中,我们报告了一例2岁零9个月的川崎病患儿,其冠状动脉在急性期未受累.然而,出院后仅一周,患者返回是因为我们通过超声心动图发现巨大的冠状动脉瘤并发血栓形成。尽管积极的溶栓治疗,患儿在溶栓治疗期间出现心肌缺血.幸运的是,因为及时治疗,孩子的血栓已经溶解,心肌缺血已经解决。
结论:此病例表明,对于冠状动脉瘤高危患者,超声心动图检查可能需要提前检查。当开始华法林治疗时,应添加低分子量肝素以拮抗华法林的早期促凝作用。在首次检测到冠状动脉血栓形成的情况下,积极的溶栓治疗可能是合理的,特别是在疾病过程的急性和亚急性阶段。
BACKGROUND: Coronary artery thrombosis and myocardial ischemia caused by giant coronary aneurysms are the main causes of death in children with Kawasaki disease. The use of thrombolytic therapy in children with Kawasaki disease who have coronary thrombosis is a controversial topic, especially with respect to the timing of treatment.
METHODS: In this article, we report a case of a child aged two years and nine months with Kawasaki disease whose coronary arteries had no involvement in the acute phase. However, by only one week after discharge, the patient returned because we found giant coronary aneurysms complicated by thrombosis via echocardiography. Despite aggressive thrombolytic therapy, the child developed myocardial ischemia during thrombolytic therapy. Fortunately, because of timely treatment, the child\'s thrombus has dissolved, and the myocardial ischemia has resolved.
CONCLUSIONS: This case suggests that for patients at high risk of coronary artery aneurysms, echocardiography may need to be reviewed earlier. Low-molecular-weight heparin should be added to antagonize the early procoagulant effects of warfarin when warfarin therapy is initiated. In the case of first-detected coronary thrombosis, aggressive thrombolytic therapy may be justified, particularly during the acute and subacute phases of the disease course.