Follow-up duration of echocardiography in patients with Kawasaki disease with no initial coronary aneurysms

AbstractThrombolysis was used in 13 procedures to treat eight patients with massive thrombosis of coronary aneurysms due to Kawasaki disease. The patients have now been followed for periods ranging from 2.5 years to 7.4 years subsequent to treatment. The procedures included intracoronary or intravenous infusion of urokinase and intravenous administration of tissue plasminogen activator. Thallium myocardial imaging, coronary arteriography and echocardiography were used for evaluation of the efficacy of the therapy and for follow-up studies. The latest time of treatment was 17 months after the onset of the disease. No new formation of massive thrombus was observed in any of the aneurysms. In five patients, eight of 13 procedures were judged to be successful. In the four patients with symptoms of myocardial ischemia, thrombolysis was undertaken immediately after the onset of symptoms. In the other patient, thrombolysis was attempted 36 days after the onset and produced remarkable improvement in the degree of ischemia. In the other four patients with no symptoms of ischemia, the therapy was undertaken when thrombus was detected in a coronary aneurysm. Aortocoronary bypass surgery was undertaken subsequent to the thrombolytic therapy in three patients, but proved satisfactory in only one patient. At follow-up, five patients have shown improvement in the degree of myocardial ischemia after treatment. Our results suggest that careful observation is needed to detect formations of thrombus in large coronary arteries for at least 1½ years after the onset of Kawasaki disease. Even if repeated thrombolytic therapy is required, it seems to be effective in checking the progression of ischemic heart disease.

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“Giant within a giant”: a case of typical Kawasaki disease with a giant coronary aneurysm and a large coronary thrombus – a rare case report

Cardiology in the Young ◽

10.1017/s1047951117001329 ◽

2017 ◽

Vol 28 (1) ◽

pp. 147-149

Author(s):

Sandeep Rajasekharan ◽

Suneesh Kalliath ◽

Sajeev C. Govindan

Keyword(s):

Case Report ◽

Kawasaki Disease ◽

Rare Case ◽

Coronary Aneurysm ◽

Giant Coronary Aneurysm ◽

Coronary Thrombus ◽

Coronary Aneurysms ◽

Arterial Thrombus ◽

Rare Case Report

AbstractKawasaki disease is a febrile vasculitis affecting young children, which may lead to coronary aneurysms. Echocardiography, although sensitive in detecting coronary aneurysms, has a limited role in diagnosing coronary thrombus. Here we report the case of a 10-year-old boy who presented with typical features of Kawasaki disease with giant coronary aneurysms. His follow-up echocardiogram revealed coronary arterial thrombus.

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Stress perfusion cardiac magnetic resonance imaging to identify coronary aneurysms, ischaemia and fibrosis in adult patients with convalescent Kawasaki disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.3160 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Cheng ◽

R De Silva

Keyword(s):

Kawasaki Disease ◽

Adult Patients ◽

Stress Perfusion ◽

Coronary Mra ◽

Coronary Aneurysms ◽

Long Term Follow Up ◽

Artery Disease ◽

Perfusion Cmr

Abstract Background Kawasaki disease is a common cause of coronary aneurysms in early adulthood. Non-invasive imaging plays a crucial role in the diagnosis and surveillance of these patients who are known to develop ischaemia, premature coronary artery disease and have poorer long-term health outcomes. Stress perfusion cardiac MRI (CMR) is considered the “gold standard” for the assessment of ischaemia and risk stratification of major adverse cardiovascular events in patients with coronary artery disease. Its use in the long-term follow-up of patients with Kawasaki disease is particularly attractive as it avoids the use of ionising radiation. However, data on its utility, together with magnetic resonance angiography (MRA) and late gadolinium enhancement (LGE) to identify ischaemia, coronary aneurysms, and fibrosis, over long-term follow-up in this population remains limited. Purpose To evaluate the diagnostic utility of comprehensive non-invasive stress perfusion CMR to identify inducible ischaemia, coronary aneurysms and myocardial fibrosis in adult patients with convalescent Kawasaki disease. Methods We performed a retrospective review of all adult patients in our Kawasaki service who underwent stress perfusion CMR with MRA and LGE as part of routine clinical care. Data collected included the presence of inducible perfusion defects, coronary anatomy and LGE. Data was compared to contemporary CT coronary angiography (CTCA). In patients who had repeated stress perfusion CMR, changes in perfusion over time were investigated. Results Seventeen patients underwent stress perfusion CMR (total 30 scans). Seven patients underwent ≥2 scans. Median age was 21 years; 14 patients were male. Five patients (30%) had areas of inducible hypoperfusion of which 3 also had LGE. A further 2 patients had LGE with no ischaemia. Coronary MRA was performed in 12 patients (71%) and identified 14 aneurysms. In 8 patients with both MRA and CTCA, detection of aneurysms was significantly correlated (Pearson's coefficient 0.776; P value 0.024). Of the 5 patients with ischaemia, 4 patients had previous CABG. All areas of ischaemia corresponded to persistent calcified aneurysms in the responsible artery. In the 7 patients with multiple perfusion CMR scans (median follow-up 47 months), 3 patients developed new ischaemia. Conclusions Long-term surveillance of coronary arteries in adult patients with a childhood history of Kawasaki disease is crucial in the early identification and management of complications. We show that stress perfusion CMR is a useful radiation-free technique for the long-term follow-up of these young patients and is able to identify the development of new ischaemia. Coronary MRA has good agreement in the identification of aneurysms when compared to CTCA. Little is reported in the literature regarding the use of a comprehensive CMR assessment in the follow-up of adult patients with Kawasaki disease and further studies are needed to validate this approach. Funding Acknowledgement Type of funding source: None

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Abstract 171: A Mitral Regurgitation May be an Early Diagnostic Clue to Kawasaki Disease in Young Infants with Atypical Presentations

Circulation ◽

10.1161/circ.131.suppl_2.171 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Jin-Hee Oh ◽

Ji Hoon Kim ◽

Ji Eun Lee ◽

Hyo Jin Kwon ◽

Jae Young Lee ◽

...

Keyword(s):

Kawasaki Disease ◽

Mitral Regurgitation ◽

Ct Angiography ◽

Clinical Course ◽

Severe Thrombocytopenia ◽

Short Term ◽

Young Infants ◽

Coronary Aneurysms ◽

Atypical Presentations

Background: Very young infants with Kawasaki disease (KD) often present with atypical features that render diagnosis difficult and the incidence of coronary complications high. Picking up clues at early phase of KD can be critical. Herein we present 3 cases of KD in very young infants who showed mitral regurgitation (MR) around the 7th day from the onset of fever. They received IVIG around 7th fever day. However, the advice for short-term follow up echocardiography (ECHO) was neglected as clinical course thereafter were so unusual. Giant coronary aneurysms developed in all the patients later. Case 1: A 31-day-old infant got admission care for sepsis. ECHO at the 7th day from the onset of fever showed trivial MR and the patient received IVIG. Follow up ECHO was recommended, but was not conducted as clinical course was ambiguous for KD thereafter. Being treated with steroids due to skin rash and eosinophilia that masked patient’s fever, the infant reappeared to hospital with cardiogenic shock 10 days later. ECHO revealed giant aneurysms in the right coronary artery (RCA) and CT angiography for pulsating axillary masses revealed axillary aneurysms. Case 2; A 67-day-old infant was admitted with fever and persistent thrombodytopenia. ECHO done at the 5th day from the onset of fever due to red lips showed non-specific findings. Follow up ECHO at the 7th fever day showed newly developed MR. IVIG and steroids was added on for persistent fever, but severe leukocytosis ensued and clinical course was also ambiguous for KD. Defervescence was achieved with infliximab. The infant showed coronary aneurysms. Case 3; A 80-day-old infant was admitted with fever and seizure, and treated for sepsis. On the 6th day from the onset of fever, MR was shown on ECHO and the patient received IVIG and steroids. However, fever and severe anemia, left shift of leukocytes, and severe thrombocytopenia persisted for two weeks. Giant coronary aneurysms, as large as the ascending aorta, developed in the RCA. Pulsatile masses identified in the axilla were found to be large aneurysms on CT angiography. Conclusion: A newly developed MR, even trivial, around the 7th day from the onset of fever may be a clue to the diagnosis of KD and short term follow up ECHO is recommended for ongoing febrile infants younger than 3 months.

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Long-term follow-up of giant coronary aneurysms of Kawasaki disease in a non-Japanese cohort

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2021.06.045 ◽

2021 ◽

Vol 13 (4) ◽

pp. 297

Author(s):

Fanny Bajolle ◽

Léa Bergez ◽

Sophie-Guiti Malekzadeh-Milani ◽

Damien Bonnet

Keyword(s):

Kawasaki Disease ◽

Japanese Cohort ◽

Coronary Aneurysms ◽

Long Term Follow Up

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Abstract 192: Long Term Coronary Angiography of Giant Coronary Aneurysms after Kawasaki Disease in Mexican Children

Circulation ◽

10.1161/circ.131.suppl_2.192 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Luis M Garrido-Garcia ◽

Jose L Colin ◽

Alfredo Bobadilla-Aguirre

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Coronary Angiography ◽

Coronary Stenosis ◽

Unknown Etiology ◽

Coronary Artery Lesions ◽

Mexican Children ◽

Coronary Aneurysms

Kawasaki Disease (KD) is an acute febrile illness characterized by systemic vasculitis of unknown etiology. Coronary artery aneurysms (CAA), is one of the most important aspects of this disease. Some patients with KD develop giant coronary aneurysms (z-score > 10) and coronary stenosis, leading to ischemic heart disease. Objective: To determine the outcome of giant coronary artery lesions caused by KD and the value of coronary angiography in the evaluation and follow-up of coronary artery lesions in Mexican children. Materials and Methods: From our Institutional database, 34 patients (23 men and 11 women) who developed giant aneurysms from 1995 to December 2013 were identified. Information on patient demographics, catheter and surgical interventions, and most recent status was collected from medical records. Results: The average age at onset of KD was 13.5 months, and the median observational period was 70 mo. (5 to 163 mo.). During this period 11 patients showed CAA regression, 21 patients persist with CAA and 2 patients died at follow-up. In 9 patients with persistent giant CAA or coronary stenosis we performed cardiac catheterization to evaluate the coronary anatomy and findings of myocardial ischemia. Coronary bypass was performed to alleviate coronary ischemia in 1 patient, this patient developed dilated cardiomyopathy one year after the surgery and died. The overall survival rate in our series is 97%. Conclusions: Despite being a small series, the long-term survival of patients with KD complicated by giant coronary aneurysms in our center is relatively good. However further research should focus on the indications for and effectiveness of percutaneous and surgical coronary interventions.

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Cardiac Events in Kawasaki Disease With Coronary Aneurysms Revisited, A Two-center Retrospective Cohort Study in Thailand

10.21203/rs.3.rs-252578/v1 ◽

2021 ◽

Author(s):

Kanokvalee Santimahakullert ◽

Chodchanok Vijarnsorn ◽

Yuttapong Wongswadiwat ◽

Prakul Chanthong ◽

Sappaya Khrongsrattha ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Artery Bypass ◽

Coronary Intervention ◽

Ivig Treatment ◽

Cardiac Events ◽

Coronary Aneurysms ◽

Adverse Cardiac Events ◽

Percutaneous Coronary

Abstract Kawasaki disease (KD) is a common vasculitis in children, which may be complicated with coronary artery aneurysms (CAAs). We aimed to report the rates of major adverse cardiac events (MACE) and determine the risks of MACE in children diagnosed with KD and CAAs in Thailand. Data of 170 children diagnosed with KD and CAAs in two centers of Thailand between 1994 and 2019 was retrospectively reviewed. The risks of MACE were analyzed using multivariate analysis. Of 170 patients, forty-nine patients (28.8%) had giant CAAs. During the median time of follow-up (5.4 years; ranging from 22 days to 23 years), 19 patients (11.1%) experienced MACE including 12 coronary artery bypass grafting, 2 percutaneous coronary intervention and 5 patients with evidence of coronary occlusion. Coronary interventions were performed at 4 years (ranging from 0.01 to 9.5 years) after the KD diagnosis. Independent risks of MACE in KD with CAAs were from the presence of giant aneurysms (HR 16.55; 95% CI 2.52 to 108.63; p=0.003) and lack of intravenous immunoglobulin (IVIG) treatment (HR 11.43; 95% CI 2.8 to 46.62; p=0.001). The intervention-free rate at 5 and 10 years in patients with giant CAAs was 78.7% and 52.2%, respectively.Trial registration: TCTR20190125004

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Abstract 203: Long-term Outcome Of Kawasaki Disease With Giant Coronary Aneurysms Which Waste Cardiac Follow-up; A Case Report

Circulation ◽

10.1161/circ.131.suppl_2.203 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Masanori Mizuno ◽

Masahide Chikada ◽

Yoshimitsu Tsuzuki ◽

Hirokuni Ono ◽

Masaki Arima ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Cardiopulmonary Arrest ◽

Artery Aneurysm ◽

Successful Resuscitation ◽

Long Term Outcome ◽

Stenotic Lesion ◽

Coronary Aneurysms

We report 2 cases of Kawasaki disease (KD) which required surgical interventions long after initial diagnosis. Case 1: Twenty-one years-old male. He was diagnosed as KD at the age of 1. Despite he received intravenous gamma-globulin therapy, bilateral giant coronary aneurysms were formed. In addition, multiple aneurysms include abdominal, iliac and axillary arteries were formed simultaneously. Coronary angiography (CAG) was thought to be dangerous because of iliac artery aneurysm formation. He received medical follow-up with aspirin administration only. He referred to our department at the age of 13. Ischemic changes were confirmed on both treadmill exercise test and cardiac scintigraphy. CAG showed 75% right coronary artery (RCA) stenosis and 99% left main trunk stenosis. Coronary artery bypass grafting (CABG) was performed and his postoperative course has been uneventful. Case 2: Thirty-seven years-old male. He was diagnosed as KD at the age of 1. Left giant coronary aneurysms were formed and subsequently aneurysm was occluded. Aspirin was administrated, but he interrupted medication and follow-up for himself. He referred to our institution due to cardiopulmonary arrest during exercise. After successful resuscitation, CAG revealed total occlusion of RCA and 99% left coronary artery stenosis. Emergent CABG was performed and no postoperative sequel has occurred. Both cases didn’t receive sufficient assessment during the follow-up period. As a result, fatal cardiac event was occurred in case 2. Coronary aneurysm tends to change into combine aneurysmal and stenotic lesion. Long time follow up is necessary even if patients have no symptom. In addition, to decrease lost follow up patients, we should explain the risk of sudden cardiac death repeatedly and emphasis necessity of long term follow-up and medication.

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Factors affecting the duration of coronary artery lesions in patients with the Kawasaki disease: a retrospective cohort study

Pediatric Rheumatology ◽

10.1186/s12969-021-00589-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Xuting Zhang ◽

Yuee He ◽

Yiping Shao ◽

Biyao Hang ◽

Zhipeng Xu ◽

...

Keyword(s):

Platelet Count ◽

Coronary Artery ◽

Kawasaki Disease ◽

Cox Regression ◽

Ivig Treatment ◽

Coronary Artery Lesions ◽

Factors Associated ◽

Coronary Aneurysms ◽

Treatment Type

Abstract Background Coronary artery lesions (CALs) are the most severe complication of Kawasaki disease (KD). Approximately 9–20% of the patients with KD develop CAL despite receiving regular treatment (intravenous immunoglobulin [IVIG] and aspirin). Some patients develop coronary aneurysms, leading to coronary artery stenosis or thrombosis, resulting in ischaemic heart disease and significantly affect the patients’ lives. The purpose of this study was to investigate the factors associated with the duration of CAL in patients with KD. Methods The data of 464 patients with KD and CAL admitted to the Children’s Heart Centre, The Second Affiliated Hospital and Yuying Children’s Hospital from 2010 to 2018 were retrospectively analysed. Demographic and clinical information and echocardiographic follow-up data were collected. Kaplan–Meier curves were used to estimate the overall CAL duration, and the log-rank test was used to compare statistical differences. Univariate and multivariate Cox regression models were used to identify variables related to the CAL duration. Results The median CAL duration was 46 days (95% confidence interval: 41–54 days). CALs were observed in 61.5, 41.5, 33.3, 22.3, 10.3, and 7.7% of the patients at 1 month, 2 months, 3 months, 6 months, 1 year, and 2 years after the onset of KD, respectively. Univariate Cox regression model showed that sex (p = 0.016), rash symptoms (p = 0.035), delayed IVIG treatment (p = 0.022), CAL type (p < 0.001), degree of CAL (p < 0.001), white blood cell count before IVIG treatment (p = 0.019), and platelet count after IVIG treatment (p = 0.003) were statistically significant factors associated with the overall CAL duration. Multivariable Cox regression showed that delayed IVIG treatment (p = 0.020), multiple dilatations (p < 0.001), a greater degree of dilatation (p < 0.001), and higher platelet count after IVIG treatment (p = 0.007) were positively related to CAL duration. Conclusions CAL duration was affected by delayed IVIG treatment, type of CAL, degree of CAL, and platelet count after IVIG treatment. These factors should be monitored carefully during the follow-up and management of patients with KD and CAL.

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Treatment and Imaging Modalities of Giant Coronary Aneurysms Resulting from Kawasaki Disease and Presenting as Acute Inferior Wall Myocardial Infarction

Case Reports in Cardiology ◽

10.1155/2021/8878358 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Mahmood Abu Akel ◽

Yaron M. Hellman ◽

Shtiwi Sawaed ◽

Erez Sharoni ◽

Amnon Eitan ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Kawasaki Disease ◽

Bypass Surgery ◽

Coronary Bypass ◽

Inferior Wall ◽

Accurate Assessment ◽

Late Sequelae ◽

Coronary Aneurysms

Giant coronary aneurysms are late sequelae of Kawasaki disease (KD). We describe a 53-year-old patient who presented with acute myocardial infarction and proximal aneurysms of all three coronary arteries. Coronary angiography demonstrated the aneurysms, but CT angiography allowed accurate assessment of the real dimensions of the aneurysms and making the decision on the preferred method of revascularization. The patient underwent coronary bypass surgery and is asymptomatic at follow-up.

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