477 Three cases of Kawasaki disease developed at young age and with a long term follow-up

Abstract Kawasaki disease is a relatively new disease and it took years since its first discovery to find and establish precise diagnostic and therapeutic indications. We report three cases of Kawasaki disease diagnosed between 1976 and 1993, which developed vascular complications and which were followed up for more than 20 years. The first case involved a 45-year-old woman who was first diagnosed with Kawasaki disease at age 3 years old. Her condition was complicated in the acute phase by a myocardial infarction and by the development of an apical aneurysm. The second case involved a 30-years-old woman who was first diagnosed with Kawasaki disease at age 6 months. The disease was complicated by coronary aneurysms and by right coronary artery occlusion. The third case involved a 29-year-old male who received a diagnosis of Kawasaki disease at age 1 year old. Echocardiography in the acute phase showed coronary aneurysms. One year later a new echocardiography revealed a thrombosis of the right coronary artery without myocardial infarction. The coronarography confirmed the coronary aneurysms and the thrombosis. All three cases were treated with a medical therapy and were followed up with periodic imaging exams, stress tests, 24-h Holter monitorings and cardiological check-ups. With these three case reports we have highlighted the possibility of finding a population of adult patients who may come to medical attention for acute events, such as myocardial infarction, presenting complicated, and disastrous angiographic pictures: it is plausible that such a population, in addition to cardiovascular risk factors, may have developed a KD in the years of lacking diagnostic and therapeutic options.

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Abstract 212: Acute Myocardial Infarction in the Acute Phase in Kawasaki Disease in Mexican Children.

Circulation ◽

10.1161/circ.131.suppl_2.212 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

William Sarmiento-Robles ◽

Luis M Garrido-Garcia

Keyword(s):

Myocardial Infarction ◽

Kawasaki Disease ◽

Acute Phase ◽

Delayed Diagnosis ◽

Clinical Manifestations ◽

Unknown Origin ◽

Z Score ◽

Laboratory Parameters ◽

Small Series ◽

Coronary Aneurysms

Background: Kawasaki disease (KD) is an acute febrile vasculitis of unknown origin. Despite treatment with intravenous immunoglobulin during the acute phase of the disease, up to 5% of those affected will develop coronary aneurysms predisposing them to thrombotic complications that could result in myocardial infarction (AMI). In Mexico there are few reports of ischemic complications secondary to KD. Objective: To describe the clinical features, the laboratory parameters, treatment used and the outcome of children who presented with myocardial infarction during the acute phase of KD in a third level facility in Mexico City Methods: From our Institutional Database of KD we search for children who presented AMI in the acute phase of the disease from August 1995 to August 2014. We analyzed gender, age, clinical manifestations, time from the onset of the symptoms to diagnosis, laboratory parameters, treatment used, and outcome in the acute phase of the disease. Results: Eight infants were diagnosed with AMI during the study period. The median age at diagnosis was 8 months (range 2 to 53 months). Seven patients were male (87.5%). The median from the onset of the clinical manifestations to diagnosis of KD was 22 days (range 4 to 26 days). All patients developed giant coronary aneurysms (median Z-score 18.98, with a range of Z-score from 11.58 - 27.70). An abnormal EKG and abnormal perfusion tests demonstrated the myocardial infarction in all cases. Two patients died in the acute phase of cardiogenic shock, one more patient died of dilated cardiomyopathy 12 months after coronary bypass surgery with an overall mortality of 62.5% of this group. Conclusions: AMI is a fatal complication of KD. In our small series it was associated with a delayed diagnosis of the disease and therefore the development of giant coronary aneurysms. Treatment of AMI in children after KD is a medical challenge with a poor prognosis in children.

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Coronary lesions suggestive of kawasaki disease in young patients presenting with acute myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehab724.2769 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

F Solis-Jimenez ◽

H Gonzalez Pacheco ◽

J Calderon Colmenero ◽

J Cervantes Salazar ◽

D Manzur Sandoval ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Young Adults ◽

Coronary Artery ◽

Kawasaki Disease ◽

Coronary Angiography ◽

Clinical Characteristics ◽

Young Patients ◽

Coronary Aneurysms ◽

Coronary Lesions

Abstract Background Approximately 25% of patients with untreated Kawasaki disease (KD) in childhood develop coronary aneurysms, which represent a higher likelihood for the occurrence of acute myocardial infarction (AMI) in young adults. Although the clinical characteristics of young adults with KD and suspected ischemia have been studied, the available data about suggestive lesions of KD in AMI is scarce. Purpose To describe the prevalence, clinical characteristics and in-hospital mortality of young adults with AMI and coronary artery lesions suggestive of KD. Methods We conducted a retrospective study of consecutive ≤40-year old patients hospitalized with AMI and coronary angiography in a coronary care unit of a Mexican teaching hospital between 2006–2020. Patients were classified according to the presence or absence of suggestive lesions of KD sequelae such as proximal aneurysms, larger size and normal distal segments Results There were included 488 patients of 40 years of age and younger, diagnosed with AMI, in whom a coronary angiography was performed. Among them, 44 patients (9%) showed coronary aneurysm or ectasia, within this group, 16 patients (36.3%) had angiographic lesions compatible with KD. The patients were classified according to the type of coronary lesions: Angiographic lesions compatible with KD, 3.3% (n=16); Diffuse coronary artery ectasia (CAE), 5.7% (n=28); and Obstructive coronary disease (OCD), 91% (n=444). The prevalence of smoking, dyslipidemia, and hypertension were similar between the groups, whereas a history of diabetes was absent in KD patients (0%, 10.7%, and 22.1% for KD, CAE and OCD, respectively; P=0.04). At admission, ST-elevation myocardial infarction was more frequent in patients with KD (81.3%, 75%, and 67.1% for KD, CAE and OCD, respectively; P=0.35). More than half of patients with KD had coronary aneurysms in two or more vessels. The right coronary artery was the most commonly affected artery followed by the left anterior descending artery and left circumflex coronary artery (87.5%, 56.3% and 56.3%, respectively). The presence of intracoronary thrombus identified at the time of angiography was more frequent in patients with KD (62.5%, 60.7% and 44.1% for KD, CAE and OCD, respectively; P=0.09). Overall, unadjusted in-hospital mortality was 3.9% and there were no deaths in the KD group (0%, 0% and 4.3% for KD, CAE, and OCD, respectively; P=0.37). Conclusion In young patients with AMI, the sequelae of KD should be considered as a possible etiology, based on their angiographic characteristics. To bear in mind the nature of the pathogenesis is crucial to assess medical and interventional management strategies, which are not well defined yet, in order to evaluate cardiovascular risk and optimize a patient-tailored treatment, which could differ from the treatment of atherosclerotic coronary artery disease FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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Late stent thrombosis

Medicinski pregled ◽

10.2298/mpns0902079p ◽

2009 ◽

Vol 62 (1-2) ◽

pp. 79-82

Author(s):

Milovan Petrovic ◽

Miroslav Bikicki ◽

Gordana Panic ◽

Tibor Canji ◽

Ilija Srdanovic ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Artery ◽

Stent Thrombosis ◽

Acute Phase ◽

Right Coronary Artery ◽

Metal Stents ◽

Late Stent Thrombosis ◽

Right Ventricular Myocardial Infarction ◽

The Right

Introduction. Late stent thrombosis is a serious complication after stent Implantation and it can lead to the development of acute myocardial infarction or death. A case report. A 43-year-old patient was admitted to our clinic to coronary care unit. He was diagnosed with acute ST elevation myocardial reinfarction of inferoposterior localisation and with right ventricular myocardial infarction. Eighteen months ago, he had acute myocardial infarction of the same localisation, and at the same time, PCI (Percutaneous Coronary Intervention) was performed in acute phase, and two bare metal stents were implanted. Now, the patient had chest discomfort two hours before admittance, and PCI was performed once again in acute phase. The diagnostic coronarography resulted in occlusion of the right coronary artery, on the spot of the previously implanted stents. After the passage of guidewire, the artery was recanalized, and defects of artery opacification, which might have been thrombs, were noticed. The thrombs were seen on the spots of earlier implanted stents and in the posterior inteventricular and posterolateral branches of the right coronary artery. PTCA was performed and the patient received the GP IIb/IIIa antagonist therapy after which the control coronarography showed minimal defects of artery opacification, with good anterograde flow. After complete treatment the patient was in good condition. Conclusion. Late stent thrombosis, although not very often, is a very serious complication and can lead to death or acute myocardial infarction. To prevent it, it is necessary that the patient receives dual antiplatelet therapy, and that PCI procedure is performed technically correctly (suitable stent dimensions and proper stent expansion).

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ST-Elevation Myocardial Infarction (STEMI) in a Patient with Moyamoya Disease

Case Reports in Cardiology ◽

10.1155/2019/7124072 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

James Livesay ◽

Jeffrey Johnson

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Moyamoya Disease ◽

Case Reports ◽

Vascular Complications ◽

St Elevation Myocardial Infarction ◽

Heart Catheterization ◽

Renal Vasculature ◽

Short Period ◽

St Elevation

Moyamoya disease is a rare condition that is primarily reported in Asian populations, characterized by stenoocclusive intracranial angiopathy with small, fragile, and multiple collateral vessel formation. Extracranial complications, mainly abnormalities within the renal vasculature, have been described; however, there are very few case reports of cardiovascular complications in patients with Moyamoya disease. We report a 26-year-old Caucasian female with known Moyamoya disease who presented with both typical and atypical chest pain, mimicking symptoms of a previous non-ST-elevation myocardial infarction. Approximately six months prior to the current hospital admission, she underwent coronary angiography requiring percutaneous coronary intervention (PCI) with two drug-eluting stents to the right coronary artery (RCA) for a critical stenosis. Despite medical management, our patient developed inferior lead ST-elevations leading to a repeat left heart catheterization which showed clinically significant stenosis of the first obtuse marginal branch. Development of significant coronary artery stenosis in a short period of time demonstrates the clinical significance of minimal atherosclerosis in the setting of underlying fibrocellular thickening as seen in patients with Moyamoya disease. Clinicians need to be aware of the possibility of coronary involvement in addition to intracranial vascular complications in patients with Moyamoya disease and take appropriate measures to prevent or delay the development of atherosclerosis in these arteries.

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P76 Management of Giant Coronary Artery Aneurysms as a Coronary Sequelae of Kawasaki Disease – Surgical or Conservative Management?

BJS Open ◽

10.1093/bjsopen/zrab032.075 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Fang Fang Quek ◽

Robert Tulloh ◽

Fang Fang Quek

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Right Coronary Artery ◽

Cardiac Mri ◽

Mortality Rates ◽

Febrile Child ◽

High Morbidity ◽

Coronary Perfusion ◽

Coronary Aneurysms ◽

Increased Risk

Abstract Introduction Kawasaki Disease (KD) is the commonest childhood acquired heart disease in developed countries, predominantly affecting children younger than 5 years’ of age. These patients are at high risks of developing coronary arterial aneurysms (CAA) and CAA with absolute internal luminal diameters measuring ≥8mm or Z-score ≥10 are classified as giant coronary aneurysms (GCA). Case Report A 19-year-old girl with previous history of Kawasaki disease was diagnosed with giant coronary aneurysms on echocardiograms. Her subsequent CT coronary angiography showed large aneurysms in the right coronary artery (29mm x 25mm) and left anterior descending artery (10mm x 10mm) with signs of calcification. However, surprisingly, despite the evidence of large coronary aneurysms, she was completely asymptomatic and was physically active, participating in competitive sports. Her cardiac MRI scan 17 years after KD onset showed right coronary perfusion deficit in the distal right coronary territory but with no evidence of myocardial infarction. A repeated cardiac CT was performed and showed delayed filling of the distal right coronary artery. However, it was uncertain at this point if the aneurysm was causing true ischaemia or simply delayed perfusion. An ECG stress test was subsequently performed for further investigation which showed no significant abnormality. After having a detailed discussion in the MDT and with colleagues from San Diego, USA, a conservative approach was decided to be in the patient’s best interest. She has been advised to avoid competitive or strenuous exercise due to the associated risks. She is fit-and-well, and is currently on Warfarin variable dose and Aspirin 75mg OD, with annual cardiac MRI surveillance. Discussion 20% of KD patients develop CAA and approximately 5% of KD patients have evidence of GCA. Unlike small and medium CAA, GCA regress in a much slower and more constant rate, and they never achieve complete resolution. A Japanese retrospective study showed the 10-year coronary event-free survival rates in small, medium and giant CAA as 100%, 96% and 61% respectively (p<.001). Patients with GCA are at significantly increased risks of coronary complications and major cardiac events (48%). Despite maximal medical treatment, patients with GCA have high risks of aneurysm rupture which is associated with high mortality rates. These patients are also at lifelong risks of atherosclerosis and stenosis which may lead to myocardial ischaemia and even death. Therefore, it is absolutely essential to control for cardiovascular risk factors and adhere to strict treatment regime. These patients also require lifelong, uninterrupted cardiology follow-up in a specialist KD clinic. Catheter and surgical interventions may be indicated in some patients. There have been recent attempts in combining CABG with downsizing reconstruction for GCA in an attempt to decrease GCA diameter and improve the coronary flow rate to prevent thrombosis which has shown quite promising results. However, the decisions whether to undergo a surgical intervention should be tailored to each individual, taking into consideration all aspects of a patient, including their disease status and social life. Conclusion With an increasing prevalence of KD in UK, it is essential to always consider the diagnosis of KD in a febrile child with raised inflammatory markers, especially in patients presenting with prolonged fever (longer than 4-5 days) as a delay in commencing treatment poses a significantly increased risk of developing coronary complications which are associated with high morbidity and mortality rates.

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Right coronary artery aneurysm: Percutaneous treatment with graft-coated stent during the acute phase of myocardial infarction

International Journal of Cardiology ◽

10.1016/j.ijcard.2007.05.102 ◽

2009 ◽

Vol 131 (2) ◽

pp. e56-e58 ◽

Cited By ~ 4

Author(s):

Michele Cacucci ◽

Antonio Catanoso ◽

Paolo Valentini ◽

Angelo Lodi Rizzini ◽

Pietro Agricola ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Acute Phase ◽

Right Coronary Artery ◽

Coronary Artery Aneurysm ◽

Artery Aneurysm ◽

Percutaneous Treatment

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Child with Kawasaki Disease Complicated by A Single Right Coronary Artery

Clinical Medicine Insights Cardiology ◽

10.1177/11795468211010700 ◽

2021 ◽

Vol 15 ◽

pp. 117954682110107

Author(s):

Ryota Nakagawa ◽

Hirotaka Ishido ◽

Yoichi Iwamoto ◽

Mai Sekine ◽

Taichi Momose ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Right Coronary Artery ◽

Left Main ◽

Main Trunk ◽

Left Main Trunk ◽

Conference Abstract ◽

First Case ◽

Aneurysmal Dilation ◽

Single Right Coronary Artery

A 3-year-old boy was referred to our hospital for management of Kawasaki disease at 5 days of illness. Echocardiographic examination on admission suggested aneurysmal dilation of the right coronary artery and a possible aorta-left main trunk connection. However, detailed echocardiography at 12 days of illness revealed an abnormal bifurcation of the proximal right coronary artery and no real connection of the aorta-left main trunk, all of which indicated the presence of a single right coronary artery. These diagnoses were confirmed by selective coronary angiography, which was performed later. Considering the difficulties in diagnosing congenital coronary anomalies, which may increase the risk of future fatal events, knowing the disease entity of the congenital coronary arterial anomaly is important for the accurate evaluation of coronary arteries in patients with Kawasaki disease. To the best of our knowledge, this is the first case report of a patient with Kawasaki disease complicated by a single right coronary artery; however, following a search of the literature, we found a brief conference abstract written in Japanese relating to the same clinical condition.

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Infarto agudo do miocárdio silencioso associado a aneurisma de artéria coronária decorrente de doença de Kawasaki: relato de caso / Silent acute myocardial infarction associated with coronary artery aneurysm due to Kawasaki disease: case report

REVISTA CIÊNCIAS EM SAÚDE ◽

10.21876/rcsfmit.v8i3.767 ◽

2018 ◽

Vol 8 (3) ◽

pp. 19-22

Author(s):

Samir Duarte Ibrahim ◽

Ana Laura Lopes Potente ◽

Fernanda Pereira Maiolini

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Kawasaki Disease ◽

Distal Part ◽

Systemic Vasculitis ◽

Artery Aneurysm ◽

Inferior Wall ◽

Coronary Artery Aneurysms ◽

Coronary Aneurysms ◽

Disease Case

A doença de Kawasaki é caracterizada por uma vasculite aguda sistêmica que ocorre na grande maioria dos casos em crianças menores de cinco anos de idade. A doença tem curso autolimitado e tratamento baseado no uso de imunoglobulina intravenosa e salicilatos. A principal gravidade se dá pelas possíveis complicações, sendo a mais grave a formação de aneurismas de artérias coronárias. O presente trabalho visa relatar o caso de uma paciente que não recebeu o diagnóstico de doença de Kawasaki na infância. Na vida adulta, durante ecocardiograma diagnosticou-se uma hipocinesia de parede inferior e parte distal do septo inferior. Em posterior angiografia, verificou-se artéria coronária direita ectásica em toda a sua extensão. Trata-se de um caso raro devido à formação de aneurismas coronarianos não tratados, após anos de doença, e sua manifestação isquêmica.Palavras-Chave: Síndrome de linfonodos mucocutâneos; Doença das coronárias; Infarto do miocárdioABSTRACTKawasaki disease is characterized by the presence of acute systemic vasculitis that occurs in most of cases in children under five years of age. The disease has an auto-limited path and the treatment is based on intravenous immunoglobulin and salicylates. The main gravity is due to the possible complications, and the most serious is the formation of coronary artery aneurysms. The present work aims to report the case of a patient, who did not receive the diagnosis of Kawasaki disease in childhood. In adulthood, an inferior wall hypokinesia and a distal part of the inferior septum were diagnosed by echocardiogram. In a subsequent angiography it was verified a ectasia right coronary artery throughout its extension. This is a rare case due to the formation of untreated coronary aneurysms after years of illness associated with ischemic manifestations.Keywords: Mucocutaneous lymph node syndrome; Myocardial infarction; Coronary disease

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