CT Coronary Angiography Studies After a Mean Follow-up of 3.8 Years in Children With Kawasaki Disease and Spontaneous Defervescence

Abstract

Background: There is paucity of literature on follow-up of children with Kawasaki disease (KD) who have spontaneous defervescence during the acute stage and do not receive intravenous immunoglobulin. We report herein the role of computed tomography coronary angiography (CTCA) as an imaging modality in such situations. Methods: This prospective observational study was carried out during the period January 2016-June 2017. Children underwent CTCA on 128-slice Dual Source CT (DSCT) scanner (Somatom Definition Flash, Siemens; Germany), and 2D-echocardiography on the same day. Results: Mean age at time of diagnosis was 6.52 ± 3.13 years; range 2-14 years. Mean age at time of study was 11.03 ± 5.10 years; range 3.75-23.30 years. Mean interval between diagnosis of KD and time of present study was 3.84 ± 2.27 years. None of the patients showed any coronary artery abnormalities on either 2D-echocardiography or CTCA. While assessment of proximal segments of left main coronary artery, proximal right coronary artery, and left anterior descending artery was comparable on both 2D-echocardiography and CTCA, left circumflex artery, and distal right coronary artery could be clearly visualized only on CTCA. Conclusion: In our experience, patients with KD who have spontaneous defervescence during the acute stage and do not receive IVIg may not have significant long-term coronary sequelae. CTCA is a useful imaging modality for delineation of coronary artery in patients with KD on long term follow-up especially in older children with thick chest walls and poor acoustic windows.

Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management

“…Whittaker et al have shown that NT-pro-BNP levels were elevated in 83% patients, while troponins were increased in 68% patients [42]. 2D-echocardiography should be carried out for identification of myocarditis, pericarditis, valvular abnormalities and CAAs [48,56,57]. The electrocardiogram may show changes of myocardial strain.…”

Spontaneous defervescence and its prediction in the acute phase of Kawasaki disease

“…Reports of long-term observations in patients not receiving IVIG under the judgment of spontaneous defervescence are very limited. Recently, Dusad et al reported that none of the 19 patients with defervesced Kawasaki disease showed any coronary abnormalities 3.8 years after the disease onset ( 25 ). However, future long-term observational studies with a larger number of patients would be necessary before substantial conclusions can be drawn.…”

The Complementary Relationship Between Echocardiography and Multi-Slice Spiral CT Coronary Angiography in the Diagnosis of Coronary Artery Thrombosis in Children With Kawasaki Disease

“…Furthermore, CTCA is a useful imaging method for delineating coronary artery in KD patients for long term follow-up, especially in older children with thick chest walls and poor acoustic windows ( 21 ). CTCA allows comprehensive evaluation of coronary arteries in children with KD ( 22 ). When KD patients with CAA developed chest tightness, chest pain, shortness of breath, edema, and oliguria, clinicians should seriously suspect that patients may have myocardial infarction, even ECHO results are normal.…”