Serious sequels of Kawasaki disease

Kim, Nam Su; Menahem, Samuel

doi:10.1017/s1047951100006922

Cited by 8 publications

(5 citation statements)

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“…Prothrombotic conditions including factor V Leiden [21], essential thrombocythemia [22], and post-partum state [23] may be associated with LMCA thrombosis. Other rare causes include cocaine use [24], blunt chest trauma [25], and Kawasaki's disease [26]. In the present series coronary angiography showed luminal irregularities or milder degree of stenosis in the LMCA suggesting that the likely cause of the thrombus was rupture of an atherosclerotic plaque in the LMCA.…”

Section: Etiology Of Lmca Thrombosissupporting

confidence: 45%

Left Main Coronary Artery Thrombus: A Case Series with Different Outcomes

Gupta

Rahman

Uretsky

et al. 2005

J Thromb Thrombolysis

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Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is an uncommon condition with an extremely high mortality. The small number of reported cases prevents the development of an evidence-based approach. Hence there are no clear-cut guidelines describing the best management approach for this condition. We describe our experience with six patients who presented with LMCA thrombosis and discuss the epidemiology, etiology and management options available for this high-risk subgroup.

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Section: Etiology Of Lmca Thrombosissupporting

confidence: 45%

Left Main Coronary Artery Thrombus: A Case Series with Different Outcomes

Gupta

Rahman

Uretsky

et al. 2005

J Thromb Thrombolysis

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“…Such abnormalities have been observed in up to 20% of individuals, even after receiving a gamma globulin infusion, though only 4% to 5% still seem to develop coronary artery aneurysms [2,14]. The development of a laminated thrombus warranted warfarinisation [5]. He has remained free of thrombus since.…”

Section: Discussionmentioning

confidence: 99%

“…His echocardiogram showed an infarct of the apex of the left ventricle with resultant paradoxical movement and the presence of a laminated thrombus (Figure 1a). Intravenous heparin was commenced, subsequently changing over to warfarin, aiming for an INR level of 2-2.5 prior to his discharge [5]. Over the subsequent months, his thrombus gradually resolved, but he was left with the ventricular apical aneurysm which went on to become thin-walled, with clear evidence of paradoxical movement, dilating on left ventricular contraction (see Figure 1b).…”

Section: Case Reportmentioning

confidence: 99%

Major Complication Following Kawasaki Disease in an Infant—The Development of Apical Infarction and Aneurysm Formation

Menahem

Lefkovits

2021

Children

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Considerable advances have occurred in the understanding of Kawasaki disease, with a substantial drop in morbidity and mortality following the infusion of gamma globulin during the acute phase. Nevertheless, major complications may still occur. A 27-year-old male presented as an infant of 11 weeks when he was diagnosed as having Kawasaki disease. He was appropriately treated with aspirin and a gamma globulin infusion following his diagnosis 5 days after the onset of his illness. Despite that, he went on to develop coronary aneurysms. He represented a few weeks later with a history of inconsolable crying associated with pallor, suggestive of ischaemic chest pain. A repeat echocardiogram revealed infarction of the apex of the left ventricle with localised thrombus formation. There were persistent aneurysms within both coronary artery systems. A further infusion of gamma globulin was given. In view of the thrombus formation, he was started on warfarin. The thrombus gradually resolved with the development of a clearly defined left ventricular apical aneurysm. He has remained on warfarin, aiming for an international normalised ratio (INR) level of 2 to 2.5. He developed mild left ventricular dysfunction during late childhood, which improved following the commencement of an angiotensin-converting enzyme (ACE) inhibitor. Despite his ventricular aneurysm, there has been no documented evidence of ventricular tachycardia over the years. Repeated testing initially by nuclear perfusion scans and then by stress echocardiograms failed to show any inducible ischaemia apart from the apical ventricular aneurysm. A recent computed tomography (CT) coronary angiogram revealed an ectatic origin of the left main and the right coronary arteries with mild calcification involving the mid-portion of the latter and slight calcification of the former. His raised cholesterol level has responded well to a statin. Despite the persistence of the ventricular aneurysm, he continues to be managed conservatively, as he has remained well. The question arises as to what the long-term implications are of his left ventricle apical aneurysm. Should it be excised? Is he at risk for ventricular tachycardia and sudden death? In addition, although the coronary aneurysms have resolved, the CT coronary angiogram shows calcium plaques in both coronary arteries at the site of the earlier aneurysms. This finding raises the question as to whether all children who develop coronary artery aneurysms following Kawasaki disease should have a CT coronary angiogram performed in adulthood.

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“…The right coronary artery was normal. 2 He remained well on warfarin. Five years after presentation an approximately yearly nuclear perfusion scan at rest and following exercise suggested myocardial ischaemia.…”

Section: Casementioning

confidence: 92%