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 Torticollis as Presentation for Atypical Kawasaki Disease Complicated by Giant Coronary Artery Aneurysms

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Tracey Dyer ◽  
Paul Dancey ◽  
John Martin ◽  
Suryakant Shah
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Systemic Vasculitis ◽  
Cervical Lymphadenopathy ◽  
Febrile Illness ◽  
High Dose ◽  
Coronary Artery Aneurysms ◽  
Low Dose Aspirin ◽  
Atypical Kawasaki Disease ◽  
Mucosal Changes

Kawasaki disease (KD) is an acute systemic vasculitis of childhood. The diagnosis can be made in a patient who presents with a prolonged high fever and meeting at least four of five criteria including polymorphous rash, mucosal changes, extremity changes (including swelling and/or palmar and plantar erythema), bilateral nonsuppurative conjunctivitis, and unilateral cervical lymphadenopathy. Atypical KD refers to patients who have not met the full criteria and in whom atypical features may be present. We discuss a case of a 6-year-old male who presented to the Emergency Department with torticollis. A series of investigations for elevated inflammatory markers revealed dilated coronary artery aneurysms on echocardiogram, and thus he was diagnosed with atypical KD. His only other criteria were bilateral nonsuppurative conjunctivitis and a prior brief febrile illness. He was treated with high-dose intravenous immune globulin (IVIG) and low-dose aspirin. Low-molecular-weight heparin and atenolol were added due to the presence of giant aneurysms.

scholarly journals A Case of Kawasaki Disease with Coronary Aneurysm Responding to the 4th IVIG Treatment

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Ju Young Kim ◽  
Hyun Jung Kim
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Artery Aneurysm ◽  
Febrile Illness ◽  
Coronary Aneurysm ◽  
Ivig Treatment ◽  
Coronary Artery Aneurysms ◽  
Steroid Pulse ◽  
The Third

Kawasaki disease is an acute febrile illness that usually occurs in children younger than 5 years of age. The use of intravenous immunoglobulin (IVIG) within the first 10 days of illness has been shown to reduce the incidence of coronary artery aneurysms significantly. The relative roles of repeated doses of intravenous immunoglobulin (IVIG) are controversial in refractory Kawasaki disease (KD). Most experts recommend the second retreatment with IVIG, 2 g/kg in refractory KD. However, the dose-response effect of the third or fourth IVIG was uncertain. Although there have been a significant number of reports on new therapeutic options for refractory KD, such as steroid, infliximab, methotrexate, and other immunosuppressants, their effectiveness in reducing the prevalence of coronary artery aneurysms was unproven. We present here KD patient with small coronary artery aneurysm who is resistant to the third IVIG and steroid pulse therapy but showed improvement immediately after the infusion of the 4th IVIG on fever day 18.

scholarly journals Coronary artery aneurysms in children is not always Kawasaki disease: a case report on Takayasu arteritis

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Michelle Lee ◽  
Esra Meidan ◽  
MaryBeth Son ◽  
Audrey Dionne ◽  
Jane W. Newburger ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Takayasu Arteritis ◽  
Clinical Course ◽  
Steroid Treatment ◽  
Recurrent Fever ◽  
Coronary Artery Aneurysms ◽  
Case Presentation ◽  
Life Threatening

Abstract Background Coronary artery (CA) aneurysms in children are a rare but potentially life-threatening finding and are highly associated with Kawasaki disease (KD). Case presentation We describe a four-year-old female with a vasculitis and CA aneurysms. She had a prolonged course with recurrent fever and systemic inflammation several times upon discontinuation of steroid treatment. Due in part to the CA aneurysms, she initially was diagnosed with KD but due to the unusual clinical course, further evaluation was performed. Abdominal and chest MRI/A revealed diffuse aortitis suggestive of a large vessel vasculitis, specifically Takayasu arteritis. With treatment targeted for Takayasu arteritis, there was resolution of fever and inflammation and the CA aneurysms improved. Conclusions This case demonstrates the utility in broadening the differential diagnosis in cases of presumed KD with CA involvement in which the clinical course is atypical for KD.

Comparison of Normal and Pathological Hemodynamics in Coronary Artery Aneurysms Caused by Kawasaki Disease

2011 ◽  
Author(s):  
Dibyendu Sengupta ◽  
Jane C. Burns ◽  
Andrew Kahn ◽  
Alison L. Marsden
Keyword(s):  
Kawasaki Disease ◽  
Coronary Arteries ◽  
Assessment Tool ◽  
Febrile Illness ◽  
Patient Specific ◽  
Computational Simulations ◽  
Coronary Artery Aneurysms ◽  
The Us ◽  
Acquired Heart Disease ◽  
Left And Right

Kawasaki disease (KD) is an acute febrile illness occurring primarily in children less than 5 years of age. It is the leading cause of acquired heart disease in children, with over 4000 cases of KD diagnosed annually in the US alone. There is currently no clinical diagnostic test for KD, and diagnosis is made via a combination of symptoms including rash, swollen extremities, and fever. Approximately 20–25% of the untreated cases develop large aneurysms in the coronary arteries, which put the patient at severe risk for myocardial infarction. In this project we performed patient specific computational simulations of blood flow in aneurysmal left and right coronary arteries of a 10-year old KD patient and compared the hemodynamics to that of a normal coronary. Several relevant hemodynamic parameters such as WSS, WSS gradients and recirculation time were obtained, as a first step towards developing a risk assessment tool for thrombosis in KD patients.

scholarly journals Fifteen-minute consultation: Kawasaki disease: how to distinguish from other febrile illnesses: tricks and tips

2020 ◽  
Vol 105 (3) ◽  
pp. 152-156
Author(s):  
Alison Kelly ◽  
Katie Sales ◽  
Mary Fenton-Jones ◽  
Robert Tulloh
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Artery Aneurysm ◽  
Artery Aneurysm ◽  
Febrile Illness ◽  
Febrile Child ◽  
Coronary Artery Aneurysms ◽  
Childhood Infections ◽  
Giant Coronary Artery Aneurysm ◽  
The Many

Kawasaki disease (KD) is challenging to diagnose because there is no specific laboratory test and the presentation is often similar to common childhood infections. We highlight some of those KD diagnostic challenges. KD, a self-limiting vasculitis, can cause coronary artery aneurysms. The aim is to optimise management during the acute febrile illness to try and prevent these because a giant coronary artery aneurysm is devastating enough without thinking that it might have been prevented. The conundrum for acute paediatricians is which clinical features best distinguish the febrile child with possible KD, needing intravenous immunoglobulin, from the many other children with febrile illnesses.

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