Giant Aneurysms in Kawasaki Disease: Is Outcome Affected by Anticoagulation?

Abstract

Background: Kawasaki disease produces a vasculitis which may injure the coronary arteries and predispose these patients to early atherosclerosis. Previously, case reports have documented that Kawasaki patients may develop coronary calcifications and may die of sudden death many years after their acute illness. Ultrafast computer tomography (UCT) has been successful at detecting coronary calcifications in adults with atherosclerosis. The goal of this study is to show that UCT can be utilized as a non-invasive technique to identify Kawasaki patients at high risk for coronary disease and who would require long-term surveillance through adulthood.Methods and Results: Eighteen patients ages five to twenty-one years old with a history of Kawasaki disease were enrolled. Each patient had an UCT of the heart. There were four patients with calcifications noted. All of the four patients had: a previous history of an aneurysm, were at least five years from their acute illness, and had the calcification correlate to the previous site of aneursym formation. A calcium score was determined by the Agaston method for each calcification. The Mayo clinic guidelines for adult atherosclerosis were then used to correlate these scores with the risk of future coronary artery disease. All four patients were at moderate or greater risk of future coronary disease.Conclusion: This study indicates that UCT can be used as an effective non-invasive methodology in Kawasaki patients to successfully identify the high-risk patients predisposed to developing potential early atherosclerotic coronary artery disease.