Cardiovascular abnormalities in Kawasaki disease.

Abstract

SUMMARY Eighteen patients with Kawasaki disease underwent serial, cross sectional echocardiographic examinations to determine the extent and subsequent course of cardiac involvement in this disease. The mean follow up period was 12-3 months. Cardiovascular complications were found in a total of 10 patients (55%). Coronary artery aneurysms were detected in 6 patients (33%), pericardial effusions in two, and one patient had electrocardiographic evidence suggesting inferior myocardial infarction. Coronary artery aneurysms, seen exclusively in infants less than 12 months of age, were found in four to regress over a mean period of 7-5 months (range 1 to 13 months). Electrocardiogram, chest radiographs, and clinical examination were unhelpful in identifying those patients with coronary artery aneurysms. Eight patients (44%) were hypertensive, though only two required treatment.

Kawasaki syndrome: Cerebral and cardiovascular complications

“…', 3 In the case of cerebral infarction in a child, the differential diagnostic considerations include trauma, infection, congenital cardiac lesions, and rare hematologic, collagen vascular, and metabolic disease^.^ Aneurysms in KS patients have been found throughout the body, and may be fusiform, saccular, or present as diffuse dilatation of the entire ~e s s e l .~…”

“…Eighty-five percent of patients with KS are less than 5 years of age, with almost one-half under the age of 2.174 The etiology is unknown, with immune complex-mediated systemic vasculitis or infectious agents considered possible causes. ', 3 In the case of cerebral infarction in a child, the differential diagnostic considerations include trauma, infection, congenital cardiac lesions, and rare hematologic, collagen vascular, and metabolic disease^.^ Aneurysms in KS patients have been found throughout the body, and may be fusiform, saccular, or present as diffuse dilatation of the entire ~e s s e l .~…”

“…Aneurysms of the coronary arteries have been described from days to weeks following the onset of i l l n e~s .~ The incidence of coronary artery aneurysms has been reported as approximately 20%. 3 Fatalities from coronary thrombosis or rupture occur in 1-2% of patients,' with 90% of deaths occurring during the first 2 months after onset of illness.6 They often affect the proximal portions of the main coronary arteries, and can be reliably detected by cross-sectional echocar-di~graphy.~ The use of routine angiography is considered unnecessary. The patient with documented coronary artery aneurysms may need indefinite follow-up.…”

Platelet immune complex interaction in pathogenesis of Kawasaki disease and childhood polyarteritis.

“…In the second, in the third to fifth weeks, when the fever and systemic symptoms are subsiding and desquamation has started, a dramatic rise in the platelet count occurs and platelet aggregating material and immune complexes become detectable. (It is during this phase that aneurysms are most often detected and death from coronary artery thrombosis is most likely to occur., 8) Finally, the platelet count decreases and platelet aggregating material and immune complexes become undetectable. Patients who have survived the first two phases generally recover, but those with coronary artery aneurysms remain at risk from late complications of myocardial infarction or coronary thrombosis.…”

“…No of boys 12 1 Median (range) duration of symptoms (days) before admission to: Local hospital 6 (1-15) 32 Hospital for Sick Children 13 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) 183 No of children with: Fever 38' C 19 5 Polymorphous rash 19 1 Mucous membrane changes 18 2 Conjunctival hyperaemia Venous blood was collected from patients on admission and twice each week throughout the illness. Citrated plasma (one volume 380,, trisodium citrate to nine volumes blood) was prepared within one hour after collection by centrifugation at 1300 g for 15 minutes, and both serum and plasma were stored at -70 C until required.…”