Regression Of Coronary Aneurysms Research Articles

Abstract 191: Atherosclerosis risk and Carotid Intima-Media Thickness after Kawasaki Disease in Mexican Children

Background: Kawasaki disease (KD) is an acute febrile illness characterized by systemic vasculitis of unknown etiology. Recent studies have shown that even after resolution of the disease, endothelial dysfunction persists and may progress to premature atherosclerosis. Carotid intima-media thickness (cIMT) is a well-established indicator for atherosclerosis in both pediatric an adult patients. Objective: To assess whether patients after Kawasaki disease (KD) have increased risk factors and abnormalities suggestive of premature atherosclerosis by measuring the cIMT compared with healthy control subjects. Material and Methods: One hundred and three patients with KD aged 102.12 ± 41.82 months (61.94 ± 33.23 after the acute episode) and 83 age-matched healthy control subjects were examined for family, medical and dietary history, serum markers of atherosclerotic risk and inflammation and carotid intimal-medial thickness (CIMT) with vascular ultrasound scanning. Results: Patients and control subjects were similar in age, gender, family and dietary history, body mass index and blood pressure. We found no difference in the levels of triglycerides and glucose. And the levels of total cholesterol (162 ± 39.2 vs 150 ± 37.4), low-density lipoprotein cholesterol (102.57 ± 32.3 vs 89.6 ± 33.5), and high-density lipoprotein cholesterol (47.38 ± 17.65 vs 39.5 ± 17.54) were slightly higher with no statistical significance. The cIMT was slightly higher in the KD group (0.48 ± 0.1 vs 0.45 ± 0.15) We did found higher levels in the lipid profile and in the cIMT in children with or with regression of coronary aneurysms compared with children without coronary aneurysms. Conclusions: There is no clear evidence of increased atherosclerosis in Mexican children with KD, but there is evidence of an altered lipid profile and in the cIMT in patients with KD with coronary lesions compared with children with KD without coronary lesions the warrant further study

Coronary aneurysm reduced after coronary stenting

We describe as case of a 70-year-old man who underwent a percutaneous coronary intervention with stenting, for a severe stenosis complicated by a coronary aneurysm just distal to the stenotic site. Notably, coronary angiogram showed an immediate and progressive reduction in the size of coronary aneurysm. Curved planar reconstruction images of the enhanced CT showed no thrombus and no dissection of the coronary aneurysm. We speculate that coronary stenting might decrease the velocity of coronary flow through the stenosis. Consequently, stenting might attenuate the hydrodynamic wall stress on the aneurysm, and, in addtion, improve the degradation of the extracellular matrix structure through the regulation of matrix metalloproteinases. Regression of coronary aneurysm after stenting requires further investigations, because stenting may become a potential means for treating post-stenotic aneurysms.

Two Young Adults Who Had Acute Coronary Syndrome after Regression of Coronary Aneurysms Caused by Kawasaki Disease in Infancy

We report two young adult patients who had acute coronary syndrome after regression of coronary aneurysms caused by Kawasaki disease (KD). A 26 year-old man had acute anterior myocardial infarction at midnight after drinking alcohol. He had had bilateral coronary aneurysms caused by KD at the age of 8 months. Selective coronary angiograms (CAGs) at the age of 7 years revealed regression of both coronary aneurysms. He had no symptoms until the onset of acute myocardial infarction. The other patient was a 24 year-old man diagnosed as having a subendocardial infarction. He had had bilateral coronary aneurysms caused by KD at the age of 1 year. CAGs at the age of 9 years showed that both had regressed. It should be recognized that young adults with apparently normal coronary arteries angiographically after regression of large coronary aneurysms caused by KD may occasionally have acute coronary syndromes. We suspect intimal involvement of the coronary arterial wall after regression of the large aneurysms underlies the acute coronary syndrome in adults. Risk factors for atherosclerosis must be avoided in this population.

Regression of coronary aneurysms in patients with Kawasaki syndrome.

Coronary aneurysms were demonstrated echocardiographically in 34 of 186 patients who presented with Kawasaki syndrome between 1979 and 1983. The aneurysms were confirmed by selective coronary angiography in 27 patients and by postmortem examination in one. The 27 surviving patients with proven aneurysms were followed for 2 to 40 months (mean 15), during which they received low dose (5 to 10 mg/kg) aspirin daily. Progressive improvement and resolution of aneurysms were observed by serial echocardiography in 18 patients and confirmed by angiography in 14. Coronary aneurysms persisted, however, in nine other patients for 14 to 40 months (mean 25.7). The incidence of aneurysm resolution was higher in children less than 1 year of age at the onset of the illness than in patients older than 1 year (100% vs 50%; p less than .001). Aneurysms were more likely to resolve in girls than in boys (100% vs 42%; p less than .001). Fusiform aneurysms tended to resolve more frequently than saccular lesions (80% vs 18%; p less than .025). Aneurysms located distally in the coronary arteries appear to regress more rapidly than proximal ones. We conclude that an age of less than 1 year at the onset of Kawasaki syndrome, female sex, and fusiform aneurysm morphology are significant factors that favor resolution of coronary artery aneurysms. However, important questions remain with regard to the long-term fate and functional capabilities of these healed lesions.