scholarly journals Active aneurysm thrombosis after Kawasaki disease in an adult: Insight into anticoagulation therapy

2020 ◽  
Author(s):  
Yusuke Akazawa ◽  
Shinji Inaba ◽  
Tomohisa Sakaue ◽  
Mie Kurata ◽  
Jun Aono ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Anticoagulation Therapy ◽  
Aneurysm Thrombosis ◽  
Insight Into

Relationship between post-IVIG IgG levels and clinical outcomes in Kawasaki disease patients: new insight into the mechanism of action of IVIG

2020 ◽  
Vol 39 (12) ◽  
pp. 3747-3755
Author(s):  
Ryunosuke Goto ◽  
Ryo Inuzuka ◽  
Takahiro Shindo ◽  
Yoshiyuki Namai ◽  
Yoichiro Oda ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Outcomes ◽  
Mechanism Of Action ◽  
Insight Into

Patient-Specific Hemodynamic Simulations in a Group of Patients With Coronary Artery Aneurysms Caused by Kawasaki Disease

2013 ◽  
Author(s):  
Dibyendu Sengupta ◽  
Jane C. Burns ◽  
Andrew Kahn ◽  
Alison L. Marsden
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Thrombus Formation ◽  
Anticoagulation Therapy ◽  
Febrile Illness ◽  
Maximum Diameter ◽  
Patient Specific ◽  
Coronary Artery Aneurysms ◽  
Patients At Risk ◽  
Life Threatening

Kawasaki disease (KD) is an acute febrile illness that can result in life threatening coronary artery aneurysms in up to 25% of untreated patients. These aneurysms put patients at risk for thrombus formation, myocardial infarction and sudden death. Currently, clinical decisions are made based on anatomy alone, with aneurysm diameter > 8mm as the arbitrary cutoff for anticoagulation therapy, despite a lack of evidence for this choice. We postulate that patient specific hemodynamics may be a better predictor for the risk of thrombosis than maximum diameter alone. To quantify hemodynamics, we performed computational fluid dynamics (CFD) simulations using patient specific models with custom coronary boundary conditions.

scholarly journals Computational blood flow simulations in Kawasaki disease patients: Insight into coronary artery aneurysm hemodynamics

2018 ◽  
Vol 2017 (3) ◽  
Author(s):  
Noelia Grande Gutierrez ◽  
Andrew Kahn ◽  
Jane C Burns ◽  
Alison L Marsden
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Anticoagulation Therapy ◽  
Artery Aneurysm ◽  
Image Data ◽  
Clinical Decision ◽  
Thrombotic Risk ◽  
Flow Stagnation ◽  
Aneurysm Diameter

[first paragraph of article]Coronary artery aneurysms (CAA) as a result of Kawasaki disease (KD) create abnormal flow conditions that can ultimately lead to thrombosis, with associated risks of myocardial infarction and sudden death. The primary long-term clinical decision required for KD patients with aneurysms is whether to treat with anticoagulation therapy. Current clinical guidelines recommend CAA diameter 8 mm or Z-score >10 as the criterion for initiating systemic anticoagulation therapy. In general, these aneurysms cause regions of flow stagnation, but the complexity of their geometry including changes in diameter, tortuosity and even proximal and distal stenoses make it difficult to evaluate thrombotic risk and predict patient outcomes based solely on a single anatomical measurement taken from image data, usually the maximum aneurysm diameter. 

scholarly journals Modelling seasonal variations in the age and incidence of Kawasaki disease to explore possible infectious aetiologies

2012 ◽  
Vol 279 (1739) ◽  
pp. 2736-2743 ◽  
Author(s):  
Virginia E. Pitzer ◽  
David Burgner ◽  
Cécile Viboud ◽  
Lone Simonsen ◽  
Viggo Andreasen ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Population Mixing ◽  
Additional Information ◽  
Childhood Infections ◽  
Epidemiological Features ◽  
Model Predictions ◽  
Seasonal Epidemics ◽  
Using Data ◽  
Insight Into ◽  
Shed Light

The average age of infection is expected to vary during seasonal epidemics in a way that is predictable from the epidemiological features, such as the duration of infectiousness and the nature of population mixing. However, it is not known whether such changes can be detected and verified using routinely collected data. We examined the correlation between the weekly number and average age of cases using data on pre-vaccination measles and rotavirus. We show that age–incidence patterns can be observed and predicted for these childhood infections. Incorporating additional information about important features of the transmission dynamics improves the correspondence between model predictions and empirical data. We then explored whether knowledge of the age–incidence pattern can shed light on the epidemiological features of diseases of unknown aetiology, such as Kawasaki disease (KD). Our results indicate KD is unlikely to be triggered by a single acute immunizing infection, but is consistent with an infection of longer duration, a non-immunizing infection or co-infection with an acute agent and one with longer duration. Age–incidence patterns can lend insight into important epidemiological features of infections, providing information on transmission-relevant population mixing for known infections and clues about the aetiology of complex paediatric diseases.

scholarly journals Kawasaki Disease Complicated by Late-Onset Fatal Cerebral Infarction: A Case Report and Literature Review

2021 ◽  
Vol 9 ◽  
Author(s):  
Lin Wang ◽  
Hongyu Duan ◽  
Kaiyu Zhou ◽  
Yimin Hua ◽  
Xiaoliang Liu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Cerebral Infarction ◽  
Basal Ganglion ◽  
Cerebral Artery ◽  
Late Onset ◽  
Anticoagulation Therapy ◽  
Cardiac Complications ◽  
Intravenous Immunoglobulin Therapy ◽  
The Right

Background: Cerebral infarction is a rare neurological complication of Kawasaki disease (KD) and occurs in the acute or subacute stage. There have been no reported cases of late-onset fatal cerebral infarction presenting over 1 year after the onset of KD.Case Presentation: A 5-month-old male patient with KD received timely intravenous immunoglobulin therapy; however, extensive coronary artery aneurysms (CAA) and coronary artery thrombosis (CAT) developed 1 month later. Anticoagulation and thrombolytic agents were suggested, but the child's parents refused. Fifteen months after KD onset, an attack of syncope left him with left hemiplegia; brain computerized tomography (CT) scans revealed cerebral infarction of the right basal ganglion without hemorrhage. Magnetic resonance angiography (MRA) revealed severe stenosis of the right middle cerebral artery, and a series of tests were performed to exclude other causes of cerebral infarction. Considering the cerebral infarction and CAT, combination therapy with urokinase and low-molecular-weight heparin (LMWH) was initiated within 24 h of syncope onset, together with oral aspirin and clopidogrel. Five days later, his clinical symptoms partially regressed and he was discharged. Unfortunately, 5 days after discharge, his clinical condition suddenly deteriorated. Repeat brain CT showed hemorrhagic stroke involving the entire left cerebral area, in addition to the previous cerebral infarction in the right basal ganglion, with obvious secondary cerebral swelling and edema, which might have been caused by previous thrombolysis. Severe cerebral hernias developed quickly. Regrettably, the patient's parents abandoned treatment because of economic factors and unfavorable prognosis, and he died soon after.Conclusions: Cerebral infarction and cerebral artery stenosis can develop late, even 1 year after the onset of KD. Pediatricians should be aware of the possibility of cerebrovascular involvement in addition to cardiac complications during long-term follow-up of KD patients. Prompt anticoagulation therapy and regular neuroimaging evaluation are essential for the management of patients with KD with giant CAA and/or CAT.

Immune abnormalities in Kawasaki disease: prognostic implications and insight into pathogenesis

1991 ◽  
Vol 1 (3) ◽  
pp. 206-211 ◽  
Author(s):  
Karyl S. Barron
Keyword(s):  
Cell Adhesion ◽  
Immune System ◽  
Kawasaki Disease ◽  
Immune Responses ◽  
B Lymphocytes ◽  
Etiologic Agent ◽  
Coronary Arteritis ◽  
Lymphokine Production ◽  
Prognostic Implications ◽  
Insight Into

SummaryThere are a number of abnormalities of the immune system seen in children with Kawasaki disease that are widely integrated and lead eventually to the inflammatory response seen clinically as fever, rash, arthritis, coronary arteritis, etc. The initiating event remains a mystery, however the cascade of immune responses involves both T and B lymphocytes, lymphokine production, and cell adhesion. Until the etiologic agent(s)/ of Kawasaki disease is identified, therapeutic intervention must be directed at controlling the effects of the abnormal immunoregulation.

scholarly journals P728 Left main coronary artery thrombus found in a teenager with Kawasaki disease following cardiac arrest

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Roque ◽  
D Monteiro De Sousa ◽  
M Bowes
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Arteries ◽  
Cardiac Mri ◽  
Anticoagulation Therapy ◽  
Left Ventricular ◽  
System Response ◽  
Coronary Artery Abnormalities ◽  
Left Circumflex Artery

Abstract Background A male teenager presented with an out of hospital cardiac arrest while exercising requiring CPR and DC Cardioversion. Incidentally, he was stung by a wasp minutes before the event. After being admitted, the patient was intubated, ventilated and treated for anaphylaxis and seizures. The patient had no significant past medical or family history of note. Investigations were performed after the patient was stabilized including 15 lead ECG, 24 hours ECG monitor, Echocardiogram and blood sample for troponins and cardiomyopathy screening. The ECG and 24 Hours ECG were reported as normal. The patient also had an exercise treadmill test which showed ischaemic changes at peak exercise. Cardiomyopathy screening was negative. Echocardiogram showed globally mildly impaired left ventricular systolic function with no other significant abnormalities. The patient underwent a cardiac MRI a couple of weeks later which showed an aneurysmal and tortuous proximal left coronary artery with a thrombus and also an aneurysmal mid left circumflex artery. Anticoagulation therapy was initiated, and a Cardioverter Defibrillator was implanted. Another echo was performed focused on the LV function and visualisation of the coronary arteries. This confirmed the cardiac MRI findings, demonstrating two coronary artery aneurysms and a filling defect suggestive of thrombus in the more distal of the two aneurysms. Due to the lack of evidence of any other potential condition, a diagnosis of Kawasaki disease was made and anticoagulation therapy was continued. Conclusion Although Kawasaki disease (KD) has been investigated for over four decades, its cause is still unknown. Current understanding of the immune system response indicates response to a classic antigen, that in most patients is protective against future exposure (1). KD is an acute, self-limited vasculitis that affects young children. In a significant proportion of patients, it can originate coronary artery abnormalities, predominantly if the diagnosis is not achieved or treatment gets delayed. In the course of acute illness, the vascular architecture is destroyed by a necrotizing arteritis, causing hydrostatic pressure and leading to aneurysms in the affected areas (2). The imaging modality preferred for assessment of myocardial function and detection of coronary artery abnormalities is Echocardiography (2). In this case, given the unusual presentation of cardiac arrest and the diagnosis of KD we recommend a thorough assessment of the coronary arteries in echocardiography routinely. Abstract P728 Figure.

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