Importance of evaluation of the right coronary artery by two-dimensional echocardiography in patients after Kawasaki disease: a right parasternal approach

Abstract

We report the importance of evaluating the right coronary artery (RCA) by two-dimensional echocardiography (2DE) in the acute phase of Kawasaki disease (KD), based on our experience with three patients whose coronary artery lesions (CAL) involving the RCA were missed in the acute phase of KD. Two patients had asymptomatic occlusion of the RCA, and it was speculated that one patient had a cardiac arrest due to CAL of the RCA. An abnormal Q wave in lead III in all 3 patients had indicated stenotic lesions of the RCA. Because it is difficult to diagnose CAL by 2DE in the late period, it is essential to identify the proximal RCA using a right parasternal approach while the patient is lying in the right lateral position.

Two females with coronary artery occlusion caused by presumed Kawasaki disease would have delivered without recognition of ischaemic heart disease

“…The screening of coronary artery dilatation is needed in patients with multifocal premature ventricular contractions and abnormalities such as abnormal Q waves and negative T waves in electrocardiograms, although it is not always easy to detect the proximal portion of the coronary arteries in adults. 7,8 Our female patients had giant coronary artery aneurysms with calcification at the proximal site of both coronary arteries. One was segmental stenosis of the right coronary artery, and the other was occlusion with calcified coronary aneurysm of the right coronary artery.…”

Neonatal Kawasaki syndrome presenting as out of hospital cardiac arrest rescued by extracorporeal cardiopulmonary resuscitation

“…4 While late onset cardiac arrest due to KD has been reported by various authors, we report the first neonate suffering from KD who was rescued by extracorporeal cardiopulmonary resuscitation (ECPR). [5][6][7][8] The cause of KD is unknown but several hypotheses exist including that of an oligoclonal immune response rather than a response to a super antigen. Elevated levels of immunoglobulins are found in the sub-acute phase giving further evidence to an immune-mediated etiology for the disease.…”

“…4 While late onset cardiac arrest due to KD has been reported by various authors, we report the first neonate suffering from KD who was rescued by extracorporeal cardiopulmonary resuscitation (ECPR). 5–8…”