Kawasaki Disease with Giant Aneurysms: Long-term Outcome

Abstract

Research Article| August 01 2011 Kawasaki Disease with Giant Aneurysms: Long-term Outcome AAP Grand Rounds (2011) 26 (2): 17. https://doi.org/10.1542/gr.26-2-17 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Kawasaki Disease with Giant Aneurysms: Long-term Outcome. AAP Grand Rounds August 2011; 26 (2): 17. https://doi.org/10.1542/gr.26-2-17 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: aneurysm, kawasaki's disease Source: Suda K, Iemura M, Nishiono H, et al. Long-term prognosis of patients with Kawasaki Disease complicated by giant coronary aneurysms: a single institution experience. Circulation. 2011; 123(17): 1836– 1842; doi: https://doi.org/10.1161/CIRCULATIONAHA.110.978213Google Scholar Investigators from Kurume and Fukuoka Universities in Japan studied the longterm prognosis of patients with Kawasaki Disease (KD) complicated by giant aneurysms (GA). A total of 76 children (57 boys) with GA (diameter ≥8mm) confirmed by cardiac catheterization treated at their institution from January 1972 through January 2011 were identified. The average age of onset was 2.9 years of age. Information was obtained from chart review and patient contacts with a median follow-up of 19 years. The patients with GA had a cardiac catheterization three months after the onset of symptoms and then were seen every one to three months with a clinic visit, electrocardiogram (ECG), and echocardiogram (ECHO). Pharmacological stress scintigraphy with dipyridamole infusion was performed every two to three years and treadmill ECG stress testing was performed between scintigraphy exams. Scintigraphy and ECG stress testing were also performed for symptoms of ischemia. A follow-up cardiac catheterization was obtained six months after the initial ECHO and every two to three years thereafter. Three indications for coronary interventions were noted: clinical ischemic symptoms, no clinical ischemia but ischemic findings provoked by stress testing, and no ischemic symptoms but at least 75% stenosis of the left anterior descending artery. Treatment changed over time with aspirin given only until 1990 and warfarin administered after 1990. Intracoronary thrombolysis and bypass grafting were used until 1994, and then replaced with percutaneous transluminal coronary rotational ablation. Over the observation period, seven patients died and one was rescued with a cardiac transplantation, leaving 95% surviving 10 years, 88% surviving 20 years and 88% surviving 30 years. Catheter and surgical procedures to treat ischemia were performed in 46 (61%) patients: a mean of 1.7 interventions (range 1–7) performed 1 month to 21 years after onset of KD. Intervention was most frequently needed one month after onset of symptoms. The authors conclude that although survival of patients with KD complicated by GA is moderately good, the majority of patients require multiple catheter and surgical interventions. Remodeling of the coronary arteries apparently continues long after the onset of this disease, presumably due to ongoing inflammation of the coronary wall. Close cardiac monitoring including stress testing is mandatory long after the initial diagnosis. Dr Bratton has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. KD most frequently affects infants and young children under 5 years of age. Diagnosis relies on a group of principal symptoms: 1) fever persisting five days or more; 2) bilateral conjunctival injection; 3) changes in lips and oral cavity; 4) polymorphous exanthema; 5) changes in peripheral extremities – (acute phase) reddening of palms and soles, indurative edema; (convalescent phase) membranous desquamation from fingertips; and 6)... You do not currently have access to this content.