Abstract 218: Weekly Exercise Increases Coronary Artery Diameter: A Case Report

Abstract

Background: Studies have reported that heparin and exercise may alleviate myocardial ischemia in patients with Kawasaki disease (KD).Moreover, exercise alone can alleviate ischemic heart disease, e.g., cardiac rehabilitation in adult coronary disease. Exercise induces secretion of some growth factors and improves endothelial function. We found that exercise may play a role in physiologically increasing the diameter of the coronary artery(CA) in KD patients with history of coronary aneurysm. Clinical course: We report the case of a 9-year-old boy who had been admitted to our hospital at 6 months of age. He had long-term fever, rash, peripheral edema, conjunctivitis, and strawberry tongue and was diagnosed with KD. We treated him with a high dose of gamma globulin and pulse therapy. Despite these treatments, he developed coronary aneurysms on both sides. In the left descending artery (LAD), the aneurysmal diameter was 8 mm. We initiated treatment with warfarin and aspirin and performed angiography twice in the acute phase and at one year after admission, followed by magnetic resonance coronary angiography every 6 months. At 6 years of age, the aneurysmal changes disappeared. We stopped warfarin and started regular exercise on a weekly basis (1 hour of running and 2 hours of baseball). After initiation of exercise,echocardiography showed that LAD diameter increased from 2.8 mm to 3.5 mm. At 9 years of age, we performed angiography and intravascular ultrasound (IVUS) to determine whether this increase in diameter was due to recurrent aneurysmal change or physiological change. The diameter of the LAD was 3.5 mm (>+2 SD of normal). IVUS showed that there was a small amount of endothelial hypertrophy but no irregularity, calcification, or thrombus. Thus, we concluded that this dilatation was not an inflammatory change but a physiological change. Conclusion: Regular exercise may play a role in improving CA lesions through arterial dilatation and improvement of endothelial function.