Acute Myocardial Ischemia in Adults Secondary to Missed Kawasaki Disease in Childhood

Abstract

Coronary artery aneurysms that occur in 25% of untreated Kawasaki disease (KD) patients may remain clinically silent for decades and then thrombose resulting in myocardial infarction. Although KD is now the most common cause of acquired heart disease in children in Asia, the United States, and Western Europe, the incidence of KD in Egypt is unknown. We tested the hypothesis that young adults in Egypt presenting with acute myocardial ischemia may have coronary artery lesions due Kawasaki disease (KD) in childhood. We reviewed a total of 580 angiograms of patients ≤ 40 years of age presenting with symptoms of myocardial ischemia. Coronary artery aneurysms were noted in 46 patients (7.9 %) of whom nine presented with myocardial infarction. The likelihood of antecedent KD as the cause of the aneurysms was classified as definite (n=10), probable (n=29), or equivocal (n=7). Compared to the definite and probable groups, the equivocal group had more traditional cardiovascular risk factors, smaller sized aneurysms, and fewer coronary arteries affected. In conclusion, in a major metropolitan center in Egypt, 6.7% of adults age 40 years or younger undergoing angiography for evaluation of possible myocardial ischemia had lesions consistent with antecedent KD. Because of the unique therapeutic challenges associated with these lesions, adult cardiologists should be aware that coronary artery aneurysms in young adults may be due to missed KD in childhood.

Successful Revascularization of a Completely Occluded Right Coronary Artery by Local Thrombus Fragmentation, Thrombolysis, Thrombus Aspiration and Balloon Angioplasty in a Patient with Atypical Kawasaki Disease

“…Catheter intervention is now established as a first-line therapeutic strategy for adult patients with coronary artery disease, and has provided satisfactory therapeutic results [6]. However, in adult as well as pediatric patients with KD, limited experience with catheter interventions has been reported [4,7,8]. Options for coronary revascularization in KD generally consist of intravenous coronary thrombolysis, percutaneous coronary intervention, or coronary artery bypass grafting [9,10,11,12].…”

Kawasaki Disease: Issues in Diagnosis and Treatment - A Developing Country Perspective

“…In a recent publication from Egypt, Rizk et al have reported that 6.7 % of adults less than 40 y of age who had possible myocardial ischemia had angiographic lesions which suggested antecedent KD [32]. It has been suggested that even children who do not have overt CAA on echocardiography need long-term follow-up with CT calcium scoring [33].…”

Vasculitis in Africa

“…The commonest signs were fever, rash, oral changes, and conjunctivitis [ 18 ••]. A study from Egypt reported that 6.7% of adults aged 40 years or younger and who underwent angiography for evaluation of possible myocardial ischemia had lesions consistent with antecedent KD [ 19 ]. A Congolese study reported on a case series of 11 patients with KD seen between 2003 and 2014, of which nine of these cases were classified as complete Kawasaki disease.…”