Fate of coronary arterial aneurysms in Kawasaki disease

Suzuki, Atsushi; Kamiya, Tetsuro; Arakaki, Yoshio; Kinoshita, Yoshihisa; Kimura, Kouji

doi:10.1016/0002-9149(94)90446-4

Cited by 69 publications

(32 citation statements)

References 2 publications

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“…"Regression" of coronary aneurysms, ie, disappearance of abnormal findings on coronary angiography (CAG), often occurs within 1 to 2 years after onset and typically occurs in the case of small or medium aneurysms. 8 This regression has been reported to occur in 32 9 16 It is typical of Kawasaki disease that coronary occlusion is followed by the development of recanalized vessels and collateral flows which significantly improve findings of myocardial ischemia. 17 However, patients may often suffer symptoms of myocardial ischemia during adolescence, and may require bypass surgery or develop heart failure and arrhythmias.…”

Section: Development Of Coronary Aneurysmsmentioning

confidence: 88%

Guidelines for Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease (JCS 2008) - Digest Version -

Group¹

2010

Circ J

157

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Section: Development Of Coronary Aneurysmsmentioning

confidence: 88%

Guidelines for Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease (JCS 2008) - Digest Version -

Group¹

2010

Circ J

157

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“…Even with therapy, significant CAL still occurs in about 5%-10% of KD patients (2,3 ). These coronary lesions may undergo vascular remodeling, such as recanalization and fibrosis, and progress to stenosis along with aneurysms later in adulthood (4,5 ). Persistent CAL may be associated with impaired coronary endothelial function (6,7 ) and low-grade inflammation (8,9 ).…”

confidence: 99%

Abnormal Matrix Remodeling in Adolescents and Young Adults with Kawasaki Disease Late after Onset

Lin¹,

Chen²,

Ho³

et al. 2008

Clinical Chemistry

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Background: Patients with a history of Kawasaki disease (KD), have been found to have pericoronary and myocardial fibrosis. Serum biomarkers of fibrosis may be sensitive indices for detection of these late cardiac complications in KD patients. Methods: We studied a cohort of 60 adolescents and young adults comprising 10 KD patients with persistent coronary artery lesions (CAL) occurring at a mean (SD) time of 14.5 (4.4) years after disease onset, 25 KD patients with no CAL after disease onset, and 25 healthy age-matched volunteers. We compared laboratory data from the patients and volunteers, including lipid profile, liver function, amino-terminal propeptide of type III procollagen (PIIINP), matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), and MMP-9:TIMP-1 ratios. Severity of CAL was determined on the basis of computed tomography determinations of the frequency of aneurysms and the extent of coronary stenosis/occlusion, thrombosis, and calcification. Results: Increased PIIINP and decreased MMP-9 and TIMP-1 concentrations and decreased MMP-9:TIMP-1 ratios were found not only in KD patients with persistent CAL but also in KD patients without CAL, although to a lesser extent in the latter group. In KD patients, the concentrations of PIIINP were positively associated with the severity of coronary stenosis/occlusion (r = 0.72, P = 0.011) and with the extent of coronary thrombus (r = 0.64, P = 0.014). The concentrations of high-sensitivity C-reactive protein, however, did not differ across groups. Conclusions: Our results demonstrate alterations in extracellular matrix biomarkers in KD patients, suggesting enhanced collagen synthesis and ameliorated degradation in adolescents and young adults late after the onset of KD. We also observed an association between the concentrations of PIIINP and the extent of coronary stenosis/occlusion or thrombosis in KD patients, a finding that needs confirmation in further studies.

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“…1,2,11,12) Even though coronary aneurysms emerge, they spontaneously regress in approximately one-half of the cases. 1,10,13,14) However, coronary aneurysms that do not regress can lead to coronary arterial thrombosis and/or stenosis that may result in myocardial ischemia, infarction, or sudden cardiac death. [1][2][3][4][5][6] In particu- lar, giant coronary aneurysms with an internal diameter > 8 mm, which was presented in this case, have been reported to have the highest risk of morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction That Resulted From Poor Adherence to Medical Treatment for Giant Coronary Aneurysm

et al. 2015

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SummaryCoronary arterial complications associated with Kawasaki disease (KD), such as a giant coronary aneurysm, determine the relative risk of future cardiac events and require lifelong medical treatment. Here, we describe a 24-year-old man who developed myocardial infarction due to poor adherence to medical treatment for a giant coronary aneurysm in the chronic phase of KD. He was hospitalized two hours after the onset of chest pain. The presence of the giant coronary aneurysm made primary percutaneous coronary intervention (PCI) difficult. However, we were able to perform primary PCI successfully utilizing previous coronary computed tomography (CT) angiographic pictures as a reference. This case provides valuable insight for the management of coronary arterial complications associated with KD. Patients in the chronic phase of KD are usually asymptomatic, even in the presence of giant coronary aneurysms which have been reported to have a high risk of morbidity and mortality. Therefore, patient education is critical for preventing poor adherence to medical treatment for coronary arterial complications. In preparation for potential coronary intervention in the future, it is also useful to perform coronary CT angiography, coronary magnetic resonance (MR) angiography, and/or coronary angiography on a regular basis while patients remain free from serious cardiac events. (Int Heart J 2015; 56: 551-554) Key words: Mucocutaneous lymph node syndrome, Percutaneous coronary intervention, Coronary computed tomography angiography, Adolescent C oronary aneurysm, a major complication of Kawasaki disease (KD), requires long-term medical treatment because it can lead to myocardial ischemia, infarction, and sudden cardiac death.1-6) The formation of coronary aneurysms has dramatically decreased since intravenous immunoglobulin (IVIG) therapy was first introduced in 1984. 7)However, there are still many outpatients who suffered from KD before IVIG therapy was established. Here, we present a 24-year-old man who developed myocardial infarction due to poor adherence to medical treatment for a giant coronary aneurysm, although he was regularly followed up in our outpatient clinic. Case ReportA young man, who had a history of KD at the age of 4 years, developed two giant coronary aneurysms (one measuring 9 mm in diameter at the bifurcation of the left main trunk and the other measuring 7 mm in diameter at the proximal right coronary artery) despite high-dose aspirin treatment in the acute phase. Although the patient had been treated with dual antiplatelet therapy with aspirin and ticlopidine since then, coronary MR angiography revealed thrombus formation in the left coronary aneurysm at the age of 19 years. He was referred to our outpatient cardiology clinic for management of the thrombus, and warfarin anticoagulation therapy was initiated. At the age of 24 years, he was admitted to our hospital two hours after the onset of chest pain. A standard 12-lead ECG revealed ST-segment elevation in V 1-4 and abnormal Q waves in V 1-3 . He in...

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Fate of coronary arterial aneurysms in Kawasaki disease

Cited by 69 publications

References 2 publications

Guidelines for Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease (JCS 2008) - Digest Version -

Guidelines for Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease (JCS 2008) - Digest Version -

Abnormal Matrix Remodeling in Adolescents and Young Adults with Kawasaki Disease Late after Onset

Acute Myocardial Infarction That Resulted From Poor Adherence to Medical Treatment for Giant Coronary Aneurysm

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