Heart Transplantation in a Toddler with Cardiac Kawasaki Disease

Theodor Tirilomis,Thomas Paul,Marius Grossmann,Wolfgang Ruschewski,Anselm Bräuer,Michael Steinmetz,Friedrich A Schöndube

doi:10.3389/fsurg.2017.00021

Abstract

Kawasaki disease is very rare in Western Europe. The disease may involve coronary arteries. A 2-year-old boy diagnosed with Kawasaki disease had had seizure-like symptoms. Further evaluation revealed recurrent myocardial ischemia and myocardial infarction. Due to extraordinary extension of the coronary disease, myocardial revascularization was not feasible and the toddler underwent successful heart transplantation after 97 days on waiting list.

Highlights

A 2-year-old boy diagnosed with Kawasaki disease was initially treated with immunoglobulines and abciximab
Due to increased risk of refractory arrhythmias or cardiac decompensation, the child remained under continuous monitoring in pediatric intensive care unit (PICU) and an extracorporeal life support device was ready for use if needed
The patient is doing well but, during follow-up, the patient developed ventricular arrhythmias and recurrent pericardial effusion and endomyocardial biopsy was without signs of rejection, we treated with prednisolone

Summary

INTRODUCTION

A 2-year-old boy diagnosed with Kawasaki disease was initially treated with immunoglobulines and abciximab. The angiogram revealed coronary aneurysms (6 mm in diameter), but the more important finding was the severity and the extent of stenotic lesions of all coronary arteries (Figure 1). While waiting for transplantation, many ischemic episodes were documented (Figure 2). After 97 days on the waiting list, the boy underwent successful heart transplantation. The diseased heart showed severe changes of the coronary arteries. Transsections of explanted heart revealed severe thickening of the coronary arterial wall and multiple myocardial infarctions (Figure 4). The first endomyocardial biopsy performed 1 week after transplantation because of pericardial effusion was without signs of rejection (ISHLT grade 0R). The patient is doing well but, during follow-up, the patient developed ventricular arrhythmias and recurrent pericardial effusion and endomyocardial biopsy was without signs of rejection, we treated with prednisolone

BACKGROUND

DISCUSSION

CONCLUDING REMARKS

ETHICS STATEMENT