Background:
Kawasaki’s disease (KD) is an acute systemic vasculitis in childhood. Lesion in the coronary arteries (CA) causes an acute or chronic ischemia, myocardial infarction and sudden death.
Materials and Methods:
The study included 189 children with KD for the period of 9 years (2004 - 2013). The age of the patients at the time of the acute stage of the disease was 1 month - 12 years 8 months . Boys and girls ratio was 1.8:1. 92% of the children were ill at the age of up to 5 years. Mean follow-up period was 15,8 months. We performed coronary angiography by CT scan in 14 children and by catheter in 9 children in CCVS. Echo was done in all 189 children.
Results:
Aneurysms of CA were found in 59 (31.2%) patients according to echocardiography data. The frequency of aneurysm formation in children first year of life was higher than in children older than 1 year (41.3% and 29.3%). Thirty eight (20%) patients had multiple aneurysms. Small aneurysms with a diameter less than 5 mm were found in 16.4% of patients, average (5 - 8 mm) - in 9%, giant (greater than 8 mm) - in 5.8% of patients. Transient CA ectasia was diagnosed in 13.2% of children.
Sensitivity of echocardiography in diagnosis of CA aneurysms was 88.5% in comparison with MSCT coronary angiography, specificity - 92.3%. Mean aneurysms' diameter measured by ECHO was 7,1 ± 3,3 mm, while CT contrast study revealed 7,3 ± 3,1 mm (p> 0.05).
We found an involution of 40.2% of aneurysms during follow-up.
Thrombi were found in 8 of 11 patients with giant aneurysms by echocardiography. Five thrombi disappeared after conservative therapy, 2 increased and occluded the RCA. CA stenosis greater than 75% was revealed in 2 patients with giant aneurysms in 2 years 7 months and in 3.5 months after manifestation of KD by using coronary arteriography.
Conclusion:
Kawasaki’s disease is a frequent cause of aneurysms, thrombosis and stenosis in coronary arteries in early childhood. Giant aneurysms often predispose to occlusion of the CA. Echocardiography is a highly specific and sensitive method for the visualization of CA aneurysms and thrombi. Other methods are useful when distinguishing stenosis and thrombosis in small CA is required.
Giant coronary aneurysm in Kawasaki disease, utility of coronary computed tomography
