Prevalence of Coronary Artery Lesions on the Initial Echocardiogram in Kawasaki Syndrome

Abstract

Coronary artery lesions are frequently detected on the initial echocardiogram of children with Kawasaki syndrome. If future studies show ectasia to have a relatively high degree of specificity for Kawasaki syndrome, the initial echocardiography may be a useful adjunctive diagnostic test.

Kawasaki Disease: The Coronary Affection Perspective

“…o Acute febrile phase [days [1][2][3][4][5][6][7][8][9][10][11] ○The temperature is elevated [>104°F].…”

“…Coronary artery lesions are frequently detected on the initial echocardiogram of children with Kawasaki syndrome [7]. In order of highest to lowest frequency, the involvement of the coronary arteries is as follows: • During the acute stage, a baseline ECHO is important.…”

“…Low dose aspirin is continued for approximately 6-8 weeks and then discontinued if no coronary arterial abnormalities have been detected by echocardiography [7]. Although data are limited, authors of several case reports have suggested a possible role for thrombolysis in those suffering acute MI as a consequence of thrombus formation in aneurysms.…”

“…Less than 2% of cases has recurrences. There have been great advances in the treatment of KD with the employment of intravenous immunoglobulins [IVIG] and high-dose aspirin [ASA]; [5], however, the lack of a diagnostic test can result in significant delays in treatment, often resulting in cardiovascular sequelae ranging from asymptomatic coronary artery ectasis or aneurysm formation to giant coronary artery aneurysms with thrombosis, myocardial infarction [MI], and sudden death in 20-25% of untreated children [6,7].…”

Clinical Manifestation, Diagnostics and Treatment of Kawasaki Disease: Known Data and Unsolved Questions

“…Именно время, прошедшее от начала заболева-ния до введения ИГВВ, имеет критическое значение для предотвращения поражения КА: показано, что в группе пациентов, получивших ИГВВ в первые 7 дней, аневриз-мы образовались у 6% пациентов; в группе, получившей такую же терапию с 8-го по 10-й дни болезни -у 27%; после 10-го дня -у 36% [48]. Собственные данные подтверждают высокую зависимость частоты и тяжести поражения КА от сроков начала лечения: у детей, полу-чивших ИГВВ на 6-7-й день от начала болезни, мелкие коронарные аневризмы образовались у 16,7% пациен-тов; у получивших ИГВВ на 8-10-й день, число больных с аневризмами составило 22,3% (у 16,7% -мелкие, у 5,6% -аневризмы среднего размера); у больных, полу-чивших ИГВВ после 10-го дня, аневризмы образовались в 53,4% случаев (у 26,7% -мелкие, у 17,8% -среднего размера, у 8,9% -гигантские аневризмы).…”