Myocardial ischemia in Kawasaki disease: Follow-up study by cardiac catheterization and coronary angiography

Suzuki, Atsushi; Kamiya, Tetsuro; Ono, Yasuo; Kohata, T; Okuno, Masahiko

doi:10.1007/bf02279876

Cited by 26 publications

(8 citation statements)

References 9 publications

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“…270 Myocardial dysfunction present shortly after MI can improve, although some patients will develop adverse ventricular remodeling and ventricular aneurysms if the damage is extensive. 271 Patients who have had an MI are at further risk of subsequent MI, although the risk is reduced with effective revascularization. Tsuda et al 272 reported long-term outcomes up to 33 years after surviving MI in 60 patients.…”

Section: Natural History and Cardiovascular Disease Eventsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,749

4,124

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Natural History and Cardiovascular Disease Eventsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,749

4,124

View full text Add to dashboard Cite

show abstract

“…Indeed, it is rare to have symptoms of ischemic heart disease even in patients with severe obstructive lesions as a consequence of Kawasaki disease. 1 It is important, nonetheless, to identify those patients at risk. In this respect, most patients are too young to undergo exercise electrocardiography for evaluation of myocardial ischemia, and, even when they can be evaluated with exercise testing,' the sensitivity of this technique in diagnosing myocardial ischemia is very low.…”

mentioning

confidence: 99%

Visualization of the coronary arterial lesions in Kawasaki disease by coronary angiography

Suzuki

Kamiya

1991

Cardiol Young

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SummaryFormation of coronary aneurysms is often seen on the patients in the acute phase of Kawasaki disease by echocardiography, and after the convalescent phase, some patients show disappearance of aneurysms but some of them show combining stenotic lesions at inlets and/or outlets of aneurysms on coronary arteriography. According to follow-up studies of coronary arterial lesions, the degree of stenosis quite frequently increases and progresses over a period up to 10 years or more after the onset of the disease. The severe stenosis appears the most frequently at the proximal portion of the left anterior descending artery and secondly at the main trunk of the main coronary artery. They die suddenly or suffer from severe myocardial infarction unless they are treated with aortocoronary bypass surgery. However, it is rare to have symptoms of ischemic heart disease even in patients with severe obstructive lesions. In fact, the sensitivity of exercise testing in diagnosis of myocardial ischemia is very low. Dipyridamole thallium myocardial imaging is reasonably useful, but dipyridamole can he dangerous when it is given without the precise information of the patient's stenosis. Coronary arteriography is, therefore, essential not only to determine the appropriate treatment of the c ronary arterial lesions but also for follow-up. According to the histopathologic study, even the patients in whom coronary arterial lesions were not visualized on coronary arteriography often show some intimal proliferation. These patients may well present a problem in the future due to the sequels of angiitis. Because of this, continuous regular follow-up should be necessary, even in patients with no evidence of coronary arterial lesion.

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“…Peripheral vascular endothelial function also appears normal late after the acute illness irrespective of coronary artery involvement [95]. Kawasaki disease results in ischemic heart disease during short-to-midterm follow-up in 1–2% of patients [96]. Consequently, small numbers of children and adolescents have been treated by bypass grafting or by interventional catheter procedures.…”

Section: Resultsmentioning

confidence: 99%

Coronary Arteries in Childhood Heart Disease: Implications for Management of Young Adults

Baraona

Valente

Porayette³

et al. 2012

J Clin Exp Cardiolog

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Survival of patients with congenital heart defects has improved dramatically. Many will undergo interventional catheter or surgical procedures later in life. Others will develop atherosclerotic or post-surgical coronary heart disease. The coronary artery anatomy in patients with congenital heart disease differs substantially from that seen in the structurally normal heart. This has implications for diagnostic procedures as well as interventions. The unique epicardial course seen in some defects could impair interpretation of coronary angiograms. Interventional procedures, especially at the base of the heart, risk injuring unusually placed coronary arteries so that coronary artery anatomy must be delineated thoroughly prior to the procedure. In this review, we will describe the variants of coronary artery anatomy and their implications for interventional and surgical treatment and for sudden death during late follow-up in several types of congenital heart defects including: tetralogy of Fallot, truncus arteriosus, transposition of the great arteries, double outlet right ventricle, congenitally corrected transposition of the great arteries and defects with functionally one ventricle. We will also discuss the coronary abnormalities seen in Kawasaki disease.

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Myocardial ischemia in Kawasaki disease: Follow-up study by cardiac catheterization and coronary angiography

Cited by 26 publications

References 9 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Visualization of the coronary arterial lesions in Kawasaki disease by coronary angiography

Coronary Arteries in Childhood Heart Disease: Implications for Management of Young Adults

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