Long-term Outcome of Coronary Abnormalities in Kawasaki Disease

Abstract

OBJECT To analyze long-term outcome of coronary abnormalities in patients with Kawasaki disease (KD). SUBJECTS The subjects of this study are 46 patients who underwent coronary angiography (CAG) twice or more times in our hospital for 20 years since 1981. The age of the first CAG was 5.2±3.3 years. Sixteen patients were referred from the affiliated hospitals. RESULTS The dilated lesions were revealed on the first CAG in 34 patients; large-sized aneurysms (ANl) in 8 patients, moderate-sized aneurysms (ANm) in 12 and dilation lesions (Dil) in 14, while the stenotic lesions were found in 11 patients; occlusion (OC) in 2 patients, segmental stenosis (SS) in 4 and local stenosis(LS) in 5. Coronary abnormalities improved in 7 patients, and were aggravated in 18. The smaller dilated lesions had a tendency to improve during follow-up period, compared with moderate-sized aneurysms on the initial CAG. Four among 14 the dilated lesions with diameter of 4-5mm were already aggravated on the second CAGs. ANl changed to OC and LS at the high rate(63%), while LS has a trend to be aggravated to further stenosis as well as obstruction(80%). Most of SS could be found 1 to 3 years after the onset of KD(75%), while OC and LS could be found in any time. Some of them were found over 10 years after the onset. During the follow-up period, one patient died due to ischemic heart disease. Four patients underwent bypass-grafting, and one had PTCA with a good result. Two patients are waiting for interventional treatment. Most of ANl appeared in acute phase. However, distal Dil in a patient among the subjects changed to LS 4 years later. CONCLUSION Even though coronary dilatation was revealed on the initial CAG and no treatment was required, the patients should be followed up carefully for a long time.