Distal coronary artery abnormalities in Kawasaki disease: experience on CT coronary angiography in 176 children

Abstract

Objective Precise evaluation of coronary artery abnormalities (CAAs) in Kawasaki disease (KD) is essential. The aim of this study is to determine role of CT coronary angiography (CTCA) for detection of CAAs in distal segments of coronary arteries in patients with KD. Methods CTCA findings of KD patients with distal coronary artery involvement were compared with those on transthoracic echocardiography (TTE) during the period 2013-2021. Results Amongst 176 patients with KD who underwent CTCA (128-Slice Dual Source scanner), 23 (13.06%) had distal CAAs (right coronary - 15/23; left anterior descending - 14/23; left circumflex - 4/23 patients). CTCA identified 60 aneurysms - 37 proximal (36 fusiform; 1 saccular) and 23 distal (17 fusiform; 6 saccular); 11 patients with proximal aneurysms had distal contiguous extension; 9 patients showed non-contiguous aneurysms in both proximal and distal segments; 4 patients showed distal segment aneurysms in absence of proximal involvement of same coronary artery; 4 patients had isolated distal CAAs. On TTE, only 40 aneurysms could be identified. Further, distal CAAs could not be identified on TTE. CTCA also identified complications (thrombosis, mural calcification and stenosis) that were missed on TTE. Conclusions CAAs can, at times, occur in distal segments in isolation and also in association with, or extension of, proximal CAAs. CTCA demonstrates CAAs in distal segments of coronary arteries, including branches, in a significant number of children with KD – these cannot be detected on TTE. CTCA, therefore, may be considered as a complimentary imaging modality in children with KD who have CAAs on TTE.

Specific morphology of coronary artery aneurysms in mainly Caucasian Kawasaki Disease patients – Initial data from the Cardiac Catheterization in Kawasaki Disease registry

“…Most data relies on CT imaging, confirming distal-only CAAs as rare, as did a recent study evaluating CT coronary angiography in Indian children with KD 14 . Their study included 23/176 patients diagnosed with distal CAA(s), four of them had isolated distal coronary artery pathologies.…”

Beaded Coronary Aneurysm in Kawasaki Disease

“…The definition of a giant CAA by size in a pediatric patient is generally accepted as larger than 8 mm in diameter (or Z score >10), compared to the definition for an adult giant CAA by size of greater than 20 mm, 40 mm or 50 mm in diameter have all been proposed as a definition in the medical literature, but there is still no clear consensus on how a giant CAA should be defined for adult [ 9 ].KD should remain as one of the principal diagnoses in the differential diagnosis of a CAA with rim calcification identified in adulthood because of the prevalence of this disease, particularly in the absence of advanced coronary atherosclerosis or another definite diagnosis including FMD or autoimmune diseases. The use of CT coronary angiography would not be invasive compared to catheter angiography and can be considered as a complimentary imaging modality in children with KD who have aneurysms on transthoracic echocardiography [ 10 ].…”

Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease

“…CTCA with the current technologies of radiation optimization and fast scanning has capability to image the entire course of all coronary arteries especially left circumflex coronary artery which is difficult to evaluate on 2D-echocardiography (Figure 2 ). CTCA also allows to detect CAAs in middle and distal segments of coronary arteries[ 38 ]. These are usually missed on echocardiography (Figure 3 ).…”

“…However, these are minor considering the advantages derived and moreover advanced CT scanners with radiation optimization are now finding space in large centers. Sedation if so, needed in infants and young children is of short duration and general anesthesia is not required in our experience[ 38 - 40 ].…”

“…However, it has only a limited role in evaluation of middle and distal coronary arteries and the left circumflex coronary artery[ 41 ]. CTCA provides an ideal method for evaluation of all segments of coronary arteries[ 38 , 42 - 45 ]. Several investigators have reported a good correlation between echocardiography and CTCA for the size of the aneurysms.…”