Abstract 74: Coronary Artery Lesions in Children with Kawasaki’s Disease: A 10-Year Follow-up in Moscow

Abstract

Background: Kawasaki’s disease (KD) is an acute systemic vasculitis in childhood. Lesion in the coronary arteries (CA) causes an acute or chronic ischemia, myocardial infarction and sudden death. Materials and Methods: The study included 189 children with KD for the period of 9 years (2004 - 2013). The age of the patients at the time of the acute stage of the disease was 1 month - 12 years 8 months . Boys and girls ratio was 1.8:1. 92% of the children were ill at the age of up to 5 years. Mean follow-up period was 15,8 months. We performed coronary angiography by CT scan in 14 children and by catheter in 9 children in CCVS. Echo was done in all 189 children. Results: Aneurysms of CA were found in 59 (31.2%) patients according to echocardiography data. The frequency of aneurysm formation in children first year of life was higher than in children older than 1 year (41.3% and 29.3%). Thirty eight (20%) patients had multiple aneurysms. Small aneurysms with a diameter less than 5 mm were found in 16.4% of patients, average (5 - 8 mm) - in 9%, giant (greater than 8 mm) - in 5.8% of patients. Transient CA ectasia was diagnosed in 13.2% of children. Sensitivity of echocardiography in diagnosis of CA aneurysms was 88.5% in comparison with MSCT coronary angiography, specificity - 92.3%. Mean aneurysms' diameter measured by ECHO was 7,1 ± 3,3 mm, while CT contrast study revealed 7,3 ± 3,1 mm (p> 0.05). We found an involution of 40.2% of aneurysms during follow-up. Thrombi were found in 8 of 11 patients with giant aneurysms by echocardiography. Five thrombi disappeared after conservative therapy, 2 increased and occluded the RCA. CA stenosis greater than 75% was revealed in 2 patients with giant aneurysms in 2 years 7 months and in 3.5 months after manifestation of KD by using coronary arteriography. Conclusion: Kawasaki’s disease is a frequent cause of aneurysms, thrombosis and stenosis in coronary arteries in early childhood. Giant aneurysms often predispose to occlusion of the CA. Echocardiography is a highly specific and sensitive method for the visualization of CA aneurysms and thrombi. Other methods are useful when distinguishing stenosis and thrombosis in small CA is required.