Changes in Coronary Perfusion after Occlusion of Coronary Arteries in Kawasaki Disease

Abstract

PurposeMyocardial infarction in children with total occlusion of a coronary artery after Kawasaki disease is rare due to multiple collateral vessels. We aimed to investigate the changes in coronary perfusion associated with coronary artery occlusion after Kawasaki disease.Materials and MethodsEleven patients with coronary artery occlusion after Kawasaki disease were investigated. Serial coronary angiographies after total occlusion of a coronary artery were reviewed and the changes were described in all patients with additive information collected.ResultsThe median age at the occlusion was 5.9 years old. The interval to occlusion was 6.2±6.9 years. Four left anterior descending coronary artery total occlusions and 10 right coronary artery total occlusions were detected. Immediate coronary artery bypass graft for left anterior descending coronary artery total occlusion made right coronary total occlusion occurred in all except one patient and the intervals thereof were 1 year, 1.8 years, and 4 years. Collaterals to the left coronary artery regressed after recanalization, while new collaterals to the right coronary artery developed. In three, collaterals to the right coronary artery decreased without recanalization without clinical signs.ConclusionThe right coronary artery should be followed up carefully because of possible occlusion of new onset or changes in collaterals.

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“…At the same time, there are known a great variety of different conditions that might lead to an MI in other age groups, including Kawasaki disease [11], aortoarteritis, myocarditis, familial hypercholesterolemia, inherited arteriopathy, primary cardiomyopathy, systemic vasculitis involving the coronary arteries, drug addiction, nephrotic syndrome, storage disease, progeria, sespsis, neoplastic processes [12]. These diseases were not found in our patient after full clinical, laboratory and instrumental studies.…”

Coronary Artery Bypass Grafting with Arterial Grafts in Patients with Kawasaki Disease Affecting the Coronary Artery: a Korean Single-Center Study

“…Based on this experience, we previously suggested that the status of collaterals associated with TO of coronary arteries in KD should be evaluated regularly for the prevention of further MI. 21 …”

Clinical Outcomes of Initial Dexamethasone Treatment Combined with a Single High Dose of Intravenous Immunoglobulin for Primary Treatment of Kawasaki Disease

“…Patients with CAL were found to have increased levels of cytokines, compared to those with normal coronary arteries 23. These cytokines may mediate vascular damage and lead to CAL in KD 29. In an experimental study, high-dose IVIG inhibited the activation of monocytes, macrophages, and coronary arterial endothelial cells, whereas dexamethasone inhibited these cells, in addition to T cells, in vitro 11.…”