Adult Patients of Kawasaki Disease with Acute Myocardial Infarction Who had not been Pointed Out Coronary Artery Lesions Previously

Abstract

We experienced two adult patients of Kawasaki disease with acute myocardial infarction who had not been pointed out coronary artery lesions previously. [Case 1: 27years old. Male] He suffered from Kawasaki disease at the age of one year. He did not receive any treatment of intravenous gamma-globulin therapy or aspirin. The cardiac catheterization at the age of 7 years revealed no coronary artery lesion. Thereafter, he had received follow-up examination once a year until 17 years old. He came to our outpatient clinic again because of recent recurrent chest pain at 22 years old. Further examinations including the cardiac catheterization, the treadmill test and the myocardial scintigraphy did not show any abnormalities and we concluded that his chest pain did not result from the coronary artery lesions of Kawasaki disease. After 5 years from these examinations, he suffered from an acute myocardial infarction with total occlusion of the right coronary artery (AHA Committee Report: Segment 2). He recovered well after the emergent percutaneus transluminal coronary anigioplasty (PTCA). [Case 2: 33 years old. Male] He suffered from Kawasaki disease at the age of two years. Any coronary artery lesion was not detected at that time. He had not received follow-up examinations since a few years after the onset. He had a chest pain at 30 years after the onset and had an acute myocardial infarction next year. The cardiac catheterization revealed 99% stenosis at segment 11, and total occlusion with well developed collaterals at segment 2. He recovered well after the directional coronary atherectomy (DCA) for the lesion at segment 11. [Conclusions] The patients with Kawasaki disease at the early era have grown to the young adult. They did not receive an accurate evaluation for the coronary artery lesions by echocardiography at the acute phase of Kawasaki disease. They did not receive effective therapy of gamma-globulin either. Those patients may have concealed coronary artery lesions. These two cases demonstrate well the high risk of those patients for the sudden onset of ischemic heart disease.