Coronary Aneurysms Research Articles

Self-navigated coronary MR angiography for coronary aneurysm detection in Kawasaki disease at 3T: comparison with conventional diaphragm-navigated coronary MR angiography.

To assess the scan time, image quality, and diagnostic performance of self-navigated coronary MR angiography (SN-CMRA) for coronary aneurysm (CAA) detection in Kawasaki disease (KD) patients and compare it with diaphragm-navigated CMRA (DN-CMRA). SN-CMRA and DN-CMRA were performed on 76 pediatric patients with KD (48 males, 6.75 ± 3.59 years). Thirty-three of whom underwent coronary CT angiography (CCTA)/invasive coronary angiography (ICA). The scan time and qualitative and quantitative image quality assessment were compared between the two sequences. The diagnostic performance for CAA detection by the two approaches using CCTA/ICA as the reference standard was compared on per-patient, per-vessel, and per-segment basis. The scan time of SN-CMRA was significantly shorter than that of DN-CMRA (7.49 ± 2.31 min vs. 10.03 ± 4.47 min, p< 0.001). There was no difference in overall and segmental image quality to reach the clinical diagnostic criteria between the two sequences (all p> 0.05). No significant difference in vessel length of the three main coronary arteries was found between the two approaches (all p> 0.05). Moreover, SN-CMRA showed no difference from DN-CMRA in contrast ratio of blood-myocardium (1.25 (interquartile range [IQR], 1.06 to 1.51) vs. 1.18 (IQR, 0.95 to 1.64), p= 0.706). There was no difference in the diagnostic accuracy of SN-CMRA and DN-CMRA for CAA detection on per-patient, per-vessel, or per-segment basis (all p> 0.05). SN-CMRA at 3T showed reliable diagnostic performance and application value for CAA detection in children with KD. Compared with DN-CMRA, SN-CMRA can simplify the scanning procedure and shorten the scan time, achieving comparable image quality and diagnostic accuracy. Coronary aneurysm in children with Kawasaki disease (KD) can be detected by self-navigated coronary MR angiography (CMRA) non-invasively and without radiation, achieving comparable image quality and diagnostic performance as diaphragm-navigated CMRA while shortening scanning time. It can provide reference for risk stratification and treatment management of KD. • Evaluating the size of coronary aneurysm is important for risk stratification and treatment of Kawasaki disease. • Self-navigated coronary MR angiography (SN-CMRA) shortens scan time and achieves comparable image quality and diagnostic performance compared with diaphragm-navigated coronary MR angiography. • SN-CMRA can evaluate coronary aneurysm non-invasively and without radiation, providing information for risk stratification and treatment.

Recurrent events of acute coronary syndrome in young adult patients after Kawasaki disease.

I encountered three adult patients with major coronary artery occlusion after Kawasaki disease in childhood, who had developed again acute coronary syndrome of adults in the peripheral branches, such as the 4thsegments, the atrioventricular node artery, and the posterior descending artery, of the right coronary artery. I reviewed their clinical course and coronary angiograms. Their age at onset of acute coronary syndrome ranged from 29 to 33 years. The male patient with a previous anteroseptal myocardial infarction in children had a symptomatic occlusion of the branch of the 4thposterior descending artery at 32 years of age. Acute coronary syndrome occurred in the area of 4thatrioventricular node artery in two female patients. The collateral arteries from the circumflex artery to the 4th atrioventricular node arteries were not clearly injected. It was suspected that they had developed bilateral giant aneurysms after acute Kawasaki disease. Two patients had an acute myocardial infarction due to thrombotic occlusion in a giant aneurysm of the right coronary artery or the left anterior descending artery, and one patient had an asymptomatic coronary occlusion of the right coronary artery and left anterior descending artery in children. Occlusion of peripheral coronary arteries in adulthood can occur in patients with multi-vessel disease caused by Kawasaki disease. Recurrent events of acute coronary syndrome can occur in adults, although its prevalence may be low. Carefulfollow-up in adults is also needed in this population.

Polyarteritis nodosa with Bead-like Coronary aneurysm in identical twins.

Polyarteritis nodosa with Bead-like Coronary aneurysm in identical twins.

Kawasaki disease: patients' transition journey and recommendations for adult care.

Children who develop coronary artery aneurysms after Kawasaki disease are at risk for cardiovascular morbidity, requiring health care transition and lifelong follow-up with an adult specialist. Follow-up losses after health care transition have been reported but without outcome and patient experience evaluation. The Theoretical Domains Framework underpinned our aim to explore the required self-care behaviours and experiences of young adults' post-health care transition. A qualitative description approach was used for virtual, 1:1 interviews with 11 participants, recruited after health care transition from a regional cardiac centre in Ontario. Directed content analysis was employed. Health, psychosocial, and lifestyle challenges were compounded by a sense of loss. Six themes emerged within the Theoretical Domains Framework categories. Participants offered novel health care transition programme recommendations. The realities of health care transition involve multiple, overlapping stressors for young adults with Kawasaki disease and coronary artery aneurysms. Our findings will inform a renewed health care transition programme and will include outcome evaluation.

ОПЫТ ПРИМЕНЕНИЯ ИНФЛИКСИМАБА В ЛЕЧЕНИИ ИММУНОГЛОБУЛИН-РЕЗИСТЕНТНОЙ БОЛЕЗНИ КАВАСАКИ

Kawasaki disease (KD) is an acute systemic disease characterized by predominant damage to small and medium-sized arteries with the development of destructive-proliferative vasculitis, damage to the coronary arteries (CA) and other visceral arteries manifested by fever, changes in the mucous membranes, skin, and lymph nodes. The initial KD therapy is intravenous immunoglobulin (IVIG) at a dose of 2 g/kg coupled with acetylsalicylic acid. However, 10% to 38% may be resistant to standard therapy. There are no uniform recommendations for the management of patients with immunoglobulin-resistant KD. Possible therapies include repeated IVIG, high-dose glucocorticoids, genetically engineered biological drugs and other cytostatic drugs. Authors represent a clinical case of a 4-month-old boy with a complete form of KD, giant CA aneurysms and a resistance to the previous 4 courses of immunomodulatory therapy (2 courses of IVIG, etanercept, pulse therapy with methylprednisolone) with the effective use of the tumor necrosis factor alpha blocker, infliximab.

Gut microbiota and microbiota-derived metabolites in cardiovascular diseases.

Cardiovascular diseases, including heart failure, coronary artery disease, atherosclerosis, aneurysm, thrombosis, and hypertension, are a great economic burden and threat to human health and are the major cause of death worldwide. Recently, researchers have begun to appreciate the role of microbial ecosystems within the human body in contributing to metabolic and cardiovascular disorders. Accumulating evidence has demonstrated that the gut microbiota is closely associated with the occurrence and development of cardiovascular diseases. The gut microbiota functions as an endocrine organ that secretes bioactive metabolites that participate in the maintenance of cardiovascular homeostasis, and their dysfunction can directly influence the progression of cardiovascular disease. This review summarizes the current literature demonstrating the role of the gut microbiota in the development of cardiovascular diseases. We also highlight the mechanism by which well-documented gut microbiota-derived metabolites, especially trimethylamine N-oxide, short-chain fatty acids, and phenylacetylglutamine, promote or inhibit the pathogenesis of cardiovascular diseases. We also discuss the therapeutic potential of altering the gut microbiota and microbiota-derived metabolites to improve or prevent cardiovascular diseases.

Echocardiography and laboratory outcomes of COVID-19 in children with a history of Kawasaki disease: a preliminary observation.

Infection with SARS-CoV-2 virus has been associated with cardiovascular sequelae including multisystem inflammatory syndrome (MIS-C) in children. Patients with a prior history of Kawasaki disease, may be more susceptible to changes in echocardiographic or laboratory findings after COVID-19. The objective of this study was to investigate the echocardiographic and laboratory findings in children with a prior history of Kawasaki disease after SARS-CoV-2 infection. In this study, we performed a retrospective chart review of 41 children younger than 18 years old who were diagnosed with COVID-19 from April to August of 2022 and had a prior history KD. We included echocardiography and blood draw data obtained at the last outpatient follow-up at our hospital for KD, and within 4 months of SARS-CoV-2 infection. Echocardiographic data obtained from 82 age-matched and gender matched controls were also included for comparison. We found that COVID-19 resulted in slightly higher RCA Z-scores within the first month after infection (mean ± SE, 1.20 ± 0.18 vs. 0.83 ± 0.18, p = 0.030), although this increase did not result in coronary artery dilatation, defined as a Z-score of at least 2.5. In addition, we found that degree of RCA dilatation after COVID-19 infection was negatively correlated with the change in monocyte percentage (Pearson's correlation coefficient-0.363, p = 0.020). Moreover, RCA Z-score changes were lower in patients who received at least one dose of mRNA COVID-19 vaccine when compared those who did not receive any (mean ± SE, -0.23 ± 0.16 vs. 0.39 ± 0.17, p = 0.031). In this pilot study we found that COVID-19 infection resulted in slightly higher RCA Z-scores in children with a prior history of KD, although not large enough to be classified as coronary aneurysms. While these changes could be the result of measurement imprecision or interobserver variation, further study of the cardiac outcomes of COVID-19 infection in children with a prior history of KD are needed in the future.

Retracted: A Hemodynamic-Based Evaluation of Applying Different Types of Coronary Artery Bypass Grafts to Coronary Artery Aneurysms

Retracted: A Hemodynamic-Based Evaluation of Applying Different Types of Coronary Artery Bypass Grafts to Coronary Artery Aneurysms

Bilateral coronary artery aneurysms with chronic total occlusion of the proximal left anterior descending coronary artery and apical aneurysm in a 32-year-old man.

Bilateral coronary artery aneurysms with chronic total occlusion of the proximal left anterior descending coronary artery and apical aneurysm in a 32-year-old man.

Demystifying the three different types of COVID-19 associated multisystem inflammatory syndrome in children: Experience from a tertiary care hospital

Background: Following the coronavirus disease-2019 (COVID-19) pandemic, a new entity emerged termed as multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 (MISC) by the World Health Organization (WHO). Infection with COVID-19 triggers the formation of antibodies to viral surface epitopes. It is believed that low titer non-neutralizing antibodies may accentuate virus-triggered immune responses. The study aimed to describe the various clinical presenting features, deranged laboratory parameters, echocardiographic findings, and immediate outcome and to categorize into 3 types of MISC and find any difference among the 3 types. Methodology: Children 29-days old to 12-years old who clinically satisfied the published WHO’s case definition for MISC were included in the study. All children were subjected to serological testing for total immunoglobulin to viral spike glycoprotein, relevant blood investigations, and echocardiography. Results: Out of 50 cases, we had 24(48%) cases of MISC without shock, 12(24%) cases of Kawasaki disease-like phenotype, and 14(28%) cases of MISC with shock. Fever (96%) and respiratory complaints (64%) predominate followed by gastrointestinal (45%) and red eye (32%). The inflammatory markers were notably elevated- the median CRP was 39.6mg/L, median ESR was 70mm 1sthr, median procalcitonin was 8.2 ng/ml. There is a significant drop in inflammatory markers post-treatment (p=0.019, p=0.000, p=0.016 respectively for CRP, ESR and procalcitonin). Abnormal echocardiographic findings were seen in 46% of cases in terms of decreased ejection fraction and coronary artery aneurysms (CAA). There were 7 deaths (14%), and 42(84%) patients were successfully discharged. Conclusion: Following the COVID-19 pandemic, MISC has emerged with its characteristic clinical pattern which needs early identification and prompt treatment to prevent mortality and morbidity. Keywords: MISC; non-COVID; Eastern India; Kawasaki disease; PIMS-TS; IVIG; immunity

Non-cardiac sequelae of Kawasaki Disease. The survey study of 90 cases and literature review

Introduction and objectiveThe best-known long-term complications of Kawasaki Disease (KD) are coronary artery aneurysms. However, there are numerous case reports about other unusual chronic complications. These data are only anecdotal, and more systematic observation is missing. We aimed to detect and describe chronic non-cardiac complications of KD.Material and methodsWe surveyed parents of children with KD diagnosed between 2014 and 2019 by phone with the use of standardized questionnaire. Clinical data about the acute phase of the disease, treatment, outcome, and symptoms and signs observed within three months since KD diagnosis were recorded from the caregivers. We recruited children from 3 children’s hospitals in Warsaw and a support group on social media.ResultsNinety children met the inclusion criteria. Parents of 30 children (33%) reported some neurologic sequelae, with persistent irritability being the most common, followed by sleep disturbances, aggression, and chronic fatigue. Seventeen children (19%) suffered either arthralgia or unspecific pain in the upper and lower extremities. In nine children (10%), either atopic or seborrheic dermatitis began shortly after KD. Five children (6%) presented with ophthalmic complications.ConclusionsVarious unspecific complications may emerge after the acute phase of KD. Although correlation does not imply causation, and possible explanations of observed abnormalities are numerous, our data may enhance clinicians’ awareness of frequent and poorly understood findings observed after KD in children. It also might help reassure parents that what they observe lies within a range of common and usually transient KD sequelae.

Spontaneous resolution of new coronary artery aneurysm following guideline-directed medical therapy after drug-eluting stent implantation

Here, we present a case of a 56-year-old man with acute myocardial infarction. The patient underwent percutaneous coronary intervention (PCI) at the left main bifurcation and mid-left anterior descending artery using drugeluting stents. Four months after the PCI, the patient was readmitted for cardiac arrest. Coronary angiography (CAG) revealed stent thrombosis in the left main-toproximal left anterior descending artery and in-stent restenosis in the left main-toproximal left circumflex artery. We performed balloon angioplasty at the left main to mid-left anterior descending artery and left main to proximal left circumflex artery stents; subsequently, blood flow was fully restored. However, contrast agent extravasation was observed outside the mid-portion of the left main artery to the proximal left anterior descending artery stent, indicating the presence of a coronary artery aneurysm (CAA) outside the stent. After guideline-directed medical therapy with dual antiplatelet agents and high-intensity statins, follow-up CAG revealed near-resolution of the CAA, absence of stenotic lesions, and good blood flow.

Giant coronary aneurysm of Behcet’s disease with sudden syncope: a case report

Behcet’s disease(BD) is a chronic inflammatory vasculitis that rarely affects the arteries, making myocardial infarction unlikely. We report a 28-year-old patient who was admitted to our hospital with multiple sudden syncope. Cardiovascular risk factors such as hypertension (HT), diabetes and obesity were not found in her. Preoperatively, imaging examinations suggested thrombosis of the inferior and superior vena cava and right heart combined with coronary artery aneurysm. The patient was finally diagnosed with a huge coronary artery aneurysm proximal to the left anterior descending artery. Syncope is considered to be caused right ventricular outflow tract obstruction. The patient received a successful aneurysm resection and had an uneventful postoperative recovery.

Predictive factors of medium-giant coronary artery aneurysms in Kawasaki disease

BackgroundWe aimed to examine predictive measures for medium and giant coronary artery aneurysms (CAA) in Kawasaki disease (KD) patients.MethodsPatients who were diagnosed with KD from 2015 to 2021 were retrospectively reviewed. The clinical and laboratory data were compared between medium-giant group and non-medium-giant group.ResultsA total of 1331 KD patients were investigated, of whom 63 patients (4.7%) developed medium-giant CAA including 27 patients (2%) with giant CAA. Sex, age, fever duration, intravenous immunoglobulin (IVIG) resistance, platelet count, and albumin level independently predicted medium or giant CAA by multivariate logistic regression analysis. Male, age, duration of fever, IVIG resistance, platelet count, hemoglobin, and erythrocyte sedimentation rate were independent predictors for giant CAA. The two new scoring systems using these factors in identifying patients with medium-giant CAA and giant CAA had respectively sensitivities of 86.89% and 92.59%, and specificities of 81.65% and 87.93%. Validation in 2021 dataset (193 KD patients) showed comparable sensitivity and specificity to development dataset.ConclusionsMale, age, fever duration, IVIG resistance, platelet count, albumin, hemoglobin, and erythrocyte sedimentation rate might be significant predictors of medium and giant CAA. The sensitivity and specificity in our risk prediction model were higher than in previous research.ImpactThis is the first study to search for risk factors and establish a prediction model for the development of medium-giant CAA in the Chinese population using z-scores and absolute inner diameter values based on large sample sizes.The sensitivity and specificity in our model were higher than in previous studies.Our research could help clinicians better predict medium-giant CAA and choose more appropriate treatment.

Pre-COVID-19 Kawasaki disease and COVID-19 era multisystem inflammatory syndrome in children: A single-center experience

Context: Multisystem inflammatory syndrome in children (MIS-C) seen during the COVID-19 pandemic time most likely represents a severe variant of Kawasaki disease (KD). Aim: The aim of this study was to study the clinical difference between KD and MIS-C. Study Design: A prospective observational study of MIS-C patients was done during the COVID-19 pandemic period and a descriptive comparative study was done with available institutional data on KD. Materials and Methods: Consecutive patients admitted with clinical features of MIS-C were enrolled and compared with the available records on KD patients. Statistical Analysis Used: Qualitative data were analyzed using percentages and proportions. Quantitative data were analyzed using mean, standard deviation, and median. Differences between groups were compared with Student’s t-test for parametric continuous variables. Results: Thirty-three pre-COVID-19 KD patients and 28 MIS-C patients were compared. Median age in KD and MIS-C was 2.4 and 7.7 years, respectively (P &lt; 0.001). More gastrointestinal and neurological symptoms were seen in MIS-C (P &lt; 0.001). KD patients had more leukocytosis, raised erythrocyte sedimentation rate, and thrombocytosis. MIS-C patients had higher mean levels of procalcitonin, ferritin, troponin, and brain natriuretic peptide. Coronary artery aneurysms and mitral regurgitation occurrence were similar in both, with a higher incidence of left ventricular dysfunction in MIS-C.

Pathophysiology of Cardiac Cell Injury in Post-COVID-19 Syndrome

Abstract: Recently, the scientific community has realized that COVID-19 effects are not limited to the acute period of infection but continue beyond that to cause more prolonged pathological changes. Post-COVID syndrome is a novel concept that describes the sequelae/persistent pathophysiological changes of post-COVID-19 infection. The current hypothesis suggests the involvement of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in cardiac arrhythmias, coronary artery aneurism, acute renal injury, central nervous system degenerative diseases, vascular endothelial cell dysfunction, and pulmonary dyspnea, as well as fibrotic lung damage. Therefore, COVID-19 has been identified as a poly-syndromic and poly-systemic inflammatory disease. Post-COVID extrapulmonary complications have been observed in approximately 85% of hospitalized COVID-19 survivors and 35% of COVID-19 outpatients. Furthermore, 25% of hospitalised COVID-19 survivors developed myocardiopathy.

Incidental Finding of a Giant Left Main Coronary Artery Aneurysm as an Anterior Mediastinal Mass.

Incidental Finding of a Giant Left Main Coronary Artery Aneurysm as an Anterior Mediastinal Mass.

Echocardiographic Findings in Children with Multisystem Inflammatory Syndrome from Initial Presentation to the First Years after Discharge.

We aimed to evaluate clinical and echocardiographic features of the children diag- nosed with multisystem inflammatory syndrome related to severe acute respiratory syndrome coronavirus-2 infection and determine early and mid-term cardiovascular outcomes. We retrospectively evaluated 38 children who were diagnosed with multisystem inflammatory syndrome in our hospital between November 2020 and November 2021. Cardiovascular evaluations were performed during hospitalization, at the first, the second, and the third months after discharge, and then cardiac evaluation was repeated at 3-month intervals until a median of 24 weeks (range: 9-56 weeks). The mean age of patients was 9.6 years and 25 patients had cardiovascular involve- ment. Echocardiography showed that there was left ventricular dysfunction in 11 cases and any coronary abnormalities in 11 cases on admission. Cardiovascular involvement was most fre- quently seen in patients older than 10 years and of male sex. Severe clinical courses occurred in half of them. The mortality rate was 2.6% during hospitalization. At discharge, complete recovery was achieved in 30 cases and partial recovery was seen in 6 cases; there were 1 case with ventricular dysfunction and 5 cases with coronary abnormalities. At the last polyclinic visit, there was no case with symptoms or myocardial dysfunction, there was only 1 case with persist- ing coronary aneurysms. Cardiovascular abnormalities in patients with multisystem inflammatory syndrome show rapid resolution within the first month. We recommend long-term follow-up evaluation for coronary arteries.

Calcified coronary artery aneurysm

58-year-old woman presented to the hospital with sudden onset right sided abdominal and chest pain. Coronary angiogram demonstrated calcified aneurysms

Evaluation of the Association Between Coronary Artery Aneurysms and Concomitant Infection in Patients With Kawasaki Disease.

We analyzed the relationship between recovery from coronary artery aneurysms (CAAs) and concurrent infections in patients with Kawasaki disease (KD). The estimated median time of aneurysm persistence between patients with and without infections was compared using Kaplan-Meier survival analyses. Risk factors associated with persistent CAAs at 2 years were identified using multivariable analyses. Co-infection was confirmed in 20.5% (106/518) of patients diagnosed with KD. No significant differences regarding treatment or coronary artery outcome were identified between patients with and without infections. The estimated median time of aneurysm persistence was higher in the co-infected group (9 vs. 6 months). A maximum Z-score ≥ 4.00 at 1 month had 78% sensitivity and 83% specificity in predicting CAAs without recovery within 1 year of onset, whereas the predictability was higher within 2 years of onset, with a Z-score ≥ 4.88 (sensitivity, 92%; specificity, 91%). Concomitant infections did not affect the response to treatment or coronary artery outcomes in patients with KD.