Abstract
Cardiac catheterization has become a promising tool to assess and treat coronary artery lesions in patients with Kawasaki disease. Significant coronary artery lesions can now be treated via transcatheter route even in small children. Further development and miniaturization of this technology will help to promote widespread use to the benefit of small children suffering from coronary artery disease. The role of diagnostic and interventional coronary artery procedures in children and adolescents are discussed in this article.
Highlights
Kawasaki disease is an acute vasculitis affecting small to midsize arteries and is one of the leading cause of acquired cardiovascular disease in children
The left anterior oblique (LAO)/caudal projection profiles the left main coronary artery and is helpful for bifurcating lesions or aneurysms that may be seen in this area
There is emerging data in adults that instantaneous wave free-ratio, which avoids the use of hyperemic agents like adenosine, gives similar diagnostic accuracy compared to fractional flow reserve (FFR) with adenosine [4]
Summary
Kawasaki disease is an acute vasculitis affecting small to midsize arteries and is one of the leading cause of acquired cardiovascular disease in children. In some cases, cardiac catheterization with invasive anatomic and functional testing with intravascular ultrasound (IVUS), fractional flow reserve (FFR) measurement, and optical coherence tomography (OCT) are promising tools which can guide clinical decision making [1]. Various treatments, including angioplasty, stenting, and rotational ablation can be performed in the same setting if indicated. Such interventions are becoming increasingly common in children and pediatric interventionalists need to be familiar with these techniques. We discuss the role of coronary artery angiography, FFR, IVUS, OCT, angioplasty, stenting, and rotational ablation in children and adolescents with Kawasaki disease in this review. The reader is encouraged to refer to the recent comprehensive American Heart Association Scientific Statement regarding recommendations and evidence for performing these procedures [2]
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