Repeated quantitative angiograms in coronary arterial aneurysm in Kawasaki disease

Nakano, Hiroyuki; Ueda, Ken; Saito, Akihiro; Nojima, Keiko

doi:10.1016/0002-9149(85)90767-2

Cited by 159 publications

(48 citation statements)

References 13 publications

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“…Giant aneurysm was defined as Ͼ8 mm in diameter. 11,12 Statistical analyses included Fisher's exact test, 2-sided, and Student's t test, 2-sided, using SPSS 7.5 for Windows 95 (SPSS, Inc, Chicago, IL).…”

Section: Methodsmentioning

confidence: 99%

Initial Intravenous Gammaglobulin Treatment Failure in Kawasaki Disease

et al. 2000

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ABSTRACT. Objectives. To determine initial intravenous gammaglobulin (IVIG) treatment failures in Kawasaki disease (KD) and to report the outcome of retreatment and our use of pulse intravenous (IV) methylprednisolone and cyclophosphamide in patients with persistent KD.Study Design. Retrospective analysis of the treatment and response of children with KD over 3 years.Results. Fifty (77%) of 65 patients completely responded to a single treatment with IVIG (2 g/kg). Fifteen patients (23%) required retreatment; 10 patients fully responded but 5 had persistent disease (3 developed coronary aneurysms and 4 developed coronary artery thrombosis). Four of these 5 patients with persistent disease were treated with pulse IV methylprednisolone and 2 were also treated with IV cyclophosphamide. There was no progression of coronary aneurysms and no deaths. No initial patient characteristics predicted IVIG treatment failure or the development of coronary aneurysms.Conclusion. Nearly 23% of patients with KD may require retreatment and 8% may develop coronary aneurysm. Additional antiinflammatory therapy, such as IV methylprednisolone and IV cyclophosphamide, may be helpful in treating persistent KD. Pediatrics 2000;105(6). URL: http://www.pediatrics.org/cgi/content/full/105/6/ e78; corticosteroids, vasculitis, Kawasaki disease, heart disease, gammaglobulin therapy, cyclophosphamide.

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Section: Methodsmentioning

confidence: 99%

Initial Intravenous Gammaglobulin Treatment Failure in Kawasaki Disease

et al. 2000

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“…2,212 The likelihood that an aneurysm will resolve appears to be determined in large measure by its initial size, with smaller aneurysms having a greater likelihood of regression. 213,214 Other factors that are positively associated with the regression of aneurysms include age at onset of Kawasaki disease Ͻ1 year, fusiform rather than saccular aneurysm morphology, and aneurysm location in a distal coronary segment. 212 Vessels that do not undergo apparent resolution of abnormalities may demonstrate persistence of aneurysmal morphology, development of stenosis or occlusion, or abnormal tortuosity.…”

Section: Regression and Evolution Of Coronary Lesionsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,613

818

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Background— Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results— A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions— Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

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“…The maximal diameter of the aneurysm also affects prognosis. Giant aneurysms (>8 mm) usually remain persistently large or progress to obstructive or stenotic lesions [7]. The present case is unusual in that giant aneurysms of the left anterior descending and circumflex coronary arteries, complicated by mural thrombosis and apical infarction, showed complete resolution on follow-up angiograms 1 year later (Fig.…”

Section: Discussionmentioning

confidence: 63%