Transformation of coronary artery aneurysm to obstructive lesion and the role of collateral vessels in myocardial perfusion in patients with Kawasaki disease

Onouchi, Zenshiro; Hamaoka, Kenji; Kamiya, Yasutaka; Hayashi, Shousei; Ohmochi, Yutaka; Sakata, Kouichi; Shiraishi, Isao; Hayano, Takashi; Fukumochi, Hiroshi

doi:10.1016/0735-1097(93)90731-f

Cited by 38 publications

(17 citation statements)

References 7 publications

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“…263 The gradual progression of LMP and laminar thrombosis to obstructive lesions may be accompanied by the development of collateral vessels, particularly in the presence of segmental stenosis and in younger patients, regardless of the occurrence of MI. 269 Prompt and effective management of acute MI can improve outcomes, although the reported experience is limited. 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.…”

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

2,795

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

2,795

4,124

View full text Add to dashboard Cite

show abstract

“…However, there are some disadvantages when using CAG to assess the physiologic significance of certain dilated or stenotic lesions in the coronary circulation (7,8). Also, in infants and young children, coronary collateral arteries are often found in ischemic myocardium after KD (9,10).…”

Section: See Page 662mentioning

confidence: 98%

Estimation of myocardial hemodynamics before and after intervention in children with kawasaki disease

Ogawa

Ohkubo

Fukazawa

et al. 2004

Journal of the American College of Cardiology

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“…The extraordinary clinical presentation in this patient may be associated with good coronary collaterals. Chronic total occlusion would have contributed to the formation of good collaterals 4. Conversely, repeated myocardial hypoxia during high performance as an athlete might have contributed to coronary collateralisation, although the effects of exercise on coronary collateralisation are controversial 6…”

Section: Discussionmentioning

confidence: 99%

Left main coronary artery aneurysm with chronic total occlusion of both left coronary arteries in a young athlete

Park

Kim

Ryu

2001

Heart

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Aneurysms of the left main coronary arteries are found in 0.1% of angiograms. This case involves an athlete with a left main coronary artery aneurysm, which was combined with chronic total occlusion of the proximal left anterior descending and proximal left circumflex coronary arteries. The extraordinary clinical presentation in this patient may be associated with good coronary collaterals, which may have developed in the patient in response to chronic total occlusion of the coronary artery by the aneurysm, and repeat myocardial hypoxia during high levels of performance as a soccer player. (Heart 2001;85:e1) Keywords: coronary aneurysm; left main coronary disease; intravascular ultrasonography; electron beam computed tomography Left main (LM) coronary artery aneurysm is very rare, occurring in 0.1% of adults undergoing coronary angiography.1 Although some of these cases had associated multivessel coronary artery disease, to the best of our knowledge there has been no previous report of an LM coronary aneurysm associated with chronic total occlusion of the left anterior descending (LAD) and left circumflex (LCx) arteries at the osteum. Such findings in a young soccer player, together with a review of the possible causes, are presented here. Case reportA 31 year old man was admitted to the coronary care unit following a non-Q wave myocardial infarction which had occurred two hours earlier. He had been a soccer player since childhood and had played regularly up until a year ago. He had no risk factors for coronary artery disease and no unusual history. His physical examination was normal. Laboratory examinations, including erythrocyte sedimentation rate, C reactive protein, complete blood count, serologic test for syphilis, rheumatoid factor, antinuclear antibody, antithrombin III, protein C, and protein S, were normal. Echocardiography showed a greatly dilated LM coronary artery and mild hypokinesia at the left ventricular apex. Fluoroscopy and coronary angiography revealed a calcified giant aneurysm of the LM artery with total occlusion of the LAD and LCx arteries at the osteum ( fig 1), with good collaterals from the normal right coronary artery (RCA). Angiographies, including the cerebrovascular and peripheral arteries, were normal. Electron beam computed tomography (EBCT) confirmed the presence of a 3.0 × 1.5 cm lobulated cystic lesion with a calcification rim from the LM to the LAD and LCx coronary arteries (fig 2A). Intravascular ultrasonography (IVUS) revealed a fusiform giant aneurysm of the LM artery ( fig 2B) and a severe intimal thickening at the osteum of the LAD artery with calcification ( fig 2C). The patient underwent coronary artery bypass surgery and was discharged in a good condition. DiscussionAneurysms of the LM coronary artery are rare.1 Most reported cases of LM artery aneurysms were incidentally noticed at coronary angiography for evaluation of myocardial ischaemic symptoms. As our case presented with a small myocardial infarction, considering the regional wall motion abnormality...

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Transformation of coronary artery aneurysm to obstructive lesion and the role of collateral vessels in myocardial perfusion in patients with Kawasaki disease

Abstract: The treatment of localized stenosis may play an important role in preventing myocardial infarction in the chronic phase of Kawasaki disease.

Cited by 38 publications

References 7 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

Estimation of myocardial hemodynamics before and after intervention in children with kawasaki disease

Left main coronary artery aneurysm with chronic total occlusion of both left coronary arteries in a young athlete

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