Result of surgical treatments in patients with coronary-arterial obstructive disease after Kawasaki disease

Yoshikawa, Yoshiro; Yagihara, Toshikatsu; Kameda, Yoichi; Taniguchi, Shigeki; Tsuda, Etsuko; Kawahira, Youichi; Uemura, Hiroji; Kitamura, Soichiro

doi:10.1016/s1010-7940(00)00355-9

Cited by 64 publications

(42 citation statements)

References 15 publications

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“…Surgical management in Kawasaki disease comprises primarily coronary artery bypass grafts for obstructive lesions. [201][202][203] The diameter and length of internal mammary grafts increase with the somatic growth of children as compared with the tendency of saphenous vein grafts to shorten somewhat over time. In a recently published series, the patency rates of arterial grafts (primarily the left and right internal mammary arteries) were 94%, 82%, and 78% at 1, 5, and 10 years, respectively, whereas patency rates for venous grafts were 82%, 63%, and 36%, respectively.…”

Section: Surgical Managementmentioning

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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Section: Surgical Managementmentioning

confidence: 99%

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

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,613

818

View full text Add to dashboard Cite

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“…Another element guiding the approach in this phase is myocardial ischemia diagnosed through methods of myocardial perfusion with MIBI or thallium after physical activity or pharmacological testing with dipyridamole or adenosine. This monitoring determines the approach, which may be conservative in cases of good myocardial perfusion, or surgical, or even interventional cardiac catheterization, due to the presence of an ischemic process 4,5 .…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the surgical approach is equally stimulating because of its adequate results, but it should be restricted to patients with giant aneurysms or ischemic processes after the acute phase of the disease 4,5 .…”

Section: Discussionmentioning

confidence: 99%

“…This involution is possible and may even be significant in some cases. Therefore, in the acute phase of the disease, surgical indication, which is limited to the presence of significant dysfunction or myocardial ischemia, or both, should be very carefully considered 4,5 .…”

mentioning

confidence: 99%

“…Kawasaki disease, known since 1976 1 , has some evolutional characteristics that deserve mention [2][3][4][5][6] , among which is the reduction in coronary aneurysms with adequate anti-inflammatory treatment, which causes radical change both in the size and extension of the aneurysm, except for the rare regression of giant aneurysms 2,3,6 . This involution is possible and may even be significant in some cases.…”

mentioning

confidence: 99%

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Kawasaki disease: involution of giant coronary aneurysms after prolonged anti-inflammatory treatment

Atik

Foronda

Bustamante

2003

Arq. Bras. Cardiol.

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The patient is a 5-year-old male with Kawasaki disease, whose involution of giant aneurysms of the left coronary arteries was surprising after a prolonged period of treatment, which lasted 80 uninterrupted days and comprised anti-inflammatory drugs associated with anticoagulation agents. The distal diameters of the anterior interventricular, the diagonal, and the circumflex arteries normalized by the end of the treatment. A residual giant aneurysm localized at the beginning of the anterior interventricular artery did not cause ischemia. Continuation of the medication for a prolonged period was recommended.Kawasaki disease, known since 1976 1 , has some evolutional characteristics that deserve mention 2-6 , among which is the reduction in coronary aneurysms with adequate anti-inflammatory treatment, which causes radical change both in the size and extension of the aneurysm, except for the rare regression of giant aneurysms 2,3,6 . This involution is possible and may even be significant in some cases. Therefore, in the acute phase of the disease, surgical indication, which is limited to the presence of significant dysfunction or myocardial ischemia, or both, should be very carefully considered 4,5 .We report a case of significant involution of giant coronary aneurysms with treatment. Case ReportThe patient is a 5-year-old male with findings suggestive of Kawasaki disease in the preceding 2 months, characterized by fever, enlargement of cervical lymph nodes, and tonsillitis, followed by generalized cutaneous erythema, pruritus, and edema of the limbs after a few days, and desquamation on the 10th day. The laboratory tests indicated an active inflammatory phase with an elevated sedimentation rate of 100 mm during the first minute, C-reactive protein of 50 U, leukocytosis of 12000/mm 3 , and, approximately 10 days later, an increased number of platelets (540000/mm 3 ). Despite the treatment with acetylsalicylic acid (80mg/kg/ day), gamma globulin (2g/kg) on the forth and seventh days, in addition to general measures, the patient developed giant aneurysms in the anterior interventricular, circumflex, and right coronary arteries. These aneurysms were detected in the initial third of the cited arteries on echocardiography ( fig. 1) approximately 33 days after the beginning of the disease and were confirmed on coronary angiographic study on the 46th day of evolution, in which the right coronary artery was obstructed and filled retrogradely from the left coronary artery. The left arteries were significantly dilated halfway up their trajectories, and saccular aneurysms continued the anterior interventricular artery up to the left ventricular tip. The diagonal artery was slightly impaired ( fig. 2).Due to persistence of the elevated sedimentation rate and C-reactive protein, the treatment with high doses of acetylsalicylic acid was reinitiated on the 47th day after the beginning of the disease, interrupted on the 17th day due to gastric irritation. Laboratory tests became normal 20 days after the restart of medication, whic...

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Kawasaki Disease

Kato

2007

Cardiovascular Medicine

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Epidemiology in Japan where KD is most prevalent has been well documented by the research committee organized by the Health and Welfare Department of the Japanese government. 8 A summary of the epidemiologic picture is as follows: Kawasaki disease has increased in incidence since 1968, and the number of patients affected is now more than 190,000. Kawasaki disease affects over 6000 children each year in Japan, and the incidence is increasing by year to 150 per 100,000 children under 4 years of age. The age affected starts at 1 month of age and peaks at 1 year of age. Fifty percent of cases are under 2 years of age. Cases over 10 years of age are quite rare. Boys are affected more than girls (1.5 : 1). It is evident that KD is more prevalent in the Japanese and in Orientals than in Caucasians. There are no geographical differences in urban or rural areas, and there is wide prevalence throughout all regions of Japan. Seasonal variation is not distinct; however, there are small peaks in winter and spring. The recurrence rate is about 3.3%, and sibling cases are only 1% to 2%. Time-space clustering or outbreaks in communities are recognized; however, there is no evidence of personto-person transmission. In 1979, there were large outbreaks in Japan, but in the past 10 years, there have not been similar occurrences.The global epidemiology of KD was described by Nakamura and Yanagawa, 9 and accordingly, KD is now widely recognized all over the world. However, it is primarily identified in Japan and East Asia. In the United States, the incidence has been estimated from hospital discharge data, which showed that 4248 patients with KD were hospitalized in the year 2000. The incidence is most common in Asian and Pacific Island descendants (32.5/100,000 children less than 5 years of age), in non-Hispanic African Americans (16.9), and in Hispanics (11.1), and lowest in whites (9.1).The fatality rate was 2% in the 1970s and declined to 0.1% in the 1990s in Japan. In the U.S., the in-hospital mortality rate is 0.17% during which the peak mortality occurs 15 to 45 days after the onset of illness. 10

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Result of surgical treatments in patients with coronary-arterial obstructive disease after Kawasaki disease

Abstract: Collaborating with catheter interventions, CABG using the arterial grafts can provide attractive results in patients with obstructive coronary arteries associated with Kawasaki disease.

Cited by 64 publications

References 15 publications

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

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

Kawasaki disease: involution of giant coronary aneurysms after prolonged anti-inflammatory treatment

Kawasaki Disease

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