Two Cases of New Coronary Aneurysms That Developed in the Late Period After Kawasaki Disease

Ozawa, Junichi; Sano, Hiroshi; Hasegawa, S.; Numano, Fujito; Haniu, Hisanori; Watanabe, Kenichi; Uchiyama, Makoto; Saitoh, Akihiko

doi:10.1007/s00246-012-0543-x

Cited by 8 publications

(16 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[265][266][267] in an angiography study of 562 patients noted new dilated or expanding lesions in 15 patients. The new aneurysms occurred at sites where previous aneurysms had diminished in size but were all associated with a localized stenosis, although none were associated with cardiac events.…”

Section: Natural History and Cardiovascular Disease Eventsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,850

4,124

View full text Add to dashboard Cite

BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

show abstract

Section: Natural History and Cardiovascular Disease Eventsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,850

4,124

View full text Add to dashboard Cite

show abstract

“…Furthermore, new appearing coronary aneurysms after regression rarely occur in the late period. 18,19 The cardiac events in this report were completely unexpected. They were born in the 1970's and suffered from acute Kawasaki disease, and had been asymptomatic for many years prior to their cardiac events.…”

Section: Discussionmentioning

confidence: 63%

Cardiac events in Patients in their forties with Kawasaki disease and regression of coronary artery aneurysms

et al. 2020

View full text Add to dashboard Cite

Over a 50-year period from the first description of Kawasaki disease, we encountered three male patients with a history of Kawasaki disease, who had their first cardiac events in their forties. They were considered to have almost normal coronary arteries in the coronary angiograms when they were children and adolescents. They had no follow-up examinations after 20 years old. The 1st patient had an acute myocardial infarction, and the 2nd was a new appearance of coronary aneurysm and stenotic lesions with coronary artery calcification. The 3rd patient had unexpected sudden death. The interval from the onset of Kawasaki disease to the cardiac events ranged from 37 to 38 years. In the former two patients, coronary artery lesions could not be evaluated immediately after Kawasaki disease. Although the 3rd patient had bilateral medium-sized coronary artery aneurysms, his coronary aneurysms regressed 1 year after acute Kawasaki disease. The intimal thickening at a previous coronary aneurysm at the age of 19 was mild. The patients with regressed coronary aneurysms were asymptomatic for about 40 years after Kawasaki disease, prior to their cardiac events. Coronary artery calcification of the proximal portion of the major coronary arteries was a predictable marker in such patients. To prevent serious cardiac events in middle-aged adult patients, reevaluation of coronary artery lesions and restarting of anti-thrombotic therapy are needed. We must be aware that there are some differences in the clinical course and time of cardiac events between patients with giant aneurysms and those with medium aneurysms.

show abstract

“… 11) Within this context, a previous case series reported late CAA evolution in 2 segments of the right coronary artery (RCA) (each having a diameter of around 8 mm) after 10 years following the index KD episode in a boy. 12) In this case series, a ‘late CAA’ at the distal part of a long-stable ‘early CAA’ involving the proximal portion of circumflex artery was reported to arise after 28 years following the index KD episode in another male patient. 12) Similarly, in a boy with a history of KD episode (around 2 years of age), ‘late CAAs’ were demonstrated on coronary angiograms (CAGs) performed when he was around 8 years (presenting with a new aneurysm in RCA) and around 17 years of age (presenting with 2 other new aneurysms in RCA and left anterior descending [LAD] artery).…”

Section: Late Versus Early (Classical) Coronary Artery Aneurysms In Kawasaki Disease: Clinical and Pathogenetic Insightsmentioning

confidence: 76%

“… 1) 8) This seems in strict contradistinction to the ‘late CAAs’ that usually emerge after a substantial latent period of years to decades. 9) 10) 11) 12) 13) In a population of 562 patients with KD, 17 late CAAs (15 new-onset and 2 expanding aneurysms) were previously reported in 15 patients (3%) with a male gender predominance (n=11). 10) Time at intial diagnosis of these aneuryms was reported to range from 1.9 to 19 years with a median duration of 11.4 years.…”

Section: Late Versus Early (Classical) Coronary Artery Aneurysms In Kawasaki Disease: Clinical and Pathogenetic Insightsmentioning

confidence: 99%

“…However, CAA formation in the setting of KD might occasionally arise as a late-onset phenomenon generally presenting with new-onset CAAs or expansion of long-stable ‘early CAAs,’ and might have diverse implications. 1) 9) 10) 11) 12) 13) On the other hand, the diagnostic criteria for early CAAs (including Z score value) 1) possibly apply to the diagnosis of these late-onset aneurysms. Of note, it seems likely that ‘late CAAs’ in the setting of KD might be confused with other vascular pathologies (including atherosclerotic CAAs) on coronary imaging, and are possibly underdiagnosed in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Late Coronary Aneurysm Formation after Kawasaki Disease: a Review of Mechanistic and Clinical Aspects

Yalta

Yetkın³

et al. 2021

Korean Circ J

View full text Add to dashboard Cite

Author's summary Evolution of coronary artery aneurysms (CAAs) has been an ominous clinical finding in patients with Kawasaki disease (KD). CAAs generally emerge within the first few weeks in patients with KD, and appear to be strongly associated with the failure to timely initiate specific management strategies. CAA formation might occasionally arise as a late-onset phenomenon long after the index KD episode. Late CAAs in the setting of KD have particular mechanistic and clinical characteristics. Late CAAs in the setting of KD may be confused with other CAA types (atherosclerotic, etc.), and are possibly underdiagnosed in clinical practice.

show abstract

Two Cases of New Coronary Aneurysms That Developed in the Late Period After Kawasaki Disease

Cited by 8 publications

References 7 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Cardiac events in Patients in their forties with Kawasaki disease and regression of coronary artery aneurysms

Late Coronary Aneurysm Formation after Kawasaki Disease: a Review of Mechanistic and Clinical Aspects

Contact Info

Product

Resources

About