Small Coronary Aneurysm Research Articles

Cardiovascular manifestations in pediatric multisystem inflammatory syndrome associated with COVID-19 in a tertiary care pediatric center in Mexico City

The objective is to expose the cardiovascular alterations in patients diagnosed with pediatric inflammatory multisystem syndrome (PIMS) associated with COVID-19 during the SARS-CoV-2 pandemic, in order to understand the disease, its evolution, and optimal management upon diagnosis. Retrospective, observational, cross-sectional analytical study of patients diagnosed with PIMS according to the criteria of the World Health Organization at the National Institute of Pediatrics, from March 2020 to December 2021. During the study period, 77 patients with PIMS were diagnosed. The results showed correlation between the shock state and alteration of laboratory markers (platelets 144217.29 ± 139321.6 μL [p < 0.001], procalcitonin 27.37 ± 38.37 ng/ml [p = 0.05] and ferritin 1937.87 ± 2562.63 [p < 0.001]). The ventricular function in patients with shock was significantly lower compared to those without shock (49.6 ± 9.1% vs. 58.1 ± 8.4 %; t-Student p < 0.001), as well as injury to the left coronary artery (p = 0.02). There is a correlation between NT-proBNP and ventricular dysfunction (Kruskal-Wallis p = 0.007). Statistical significance was found in the association between death, elevation of inflammatory markers and ventricular dysfunction (p < 0.001). The cardiovascular alterations observed, in order of frequency, were pericardial effusion (25.7%), myocarditis (15%), mild ventricular dysfunction (13.5%) and small coronary aneurysm with predominance of the left coronary artery and the anterior descending one.

An atypical case of Kawasaki disease with severe pneumonia in a neonate

BackgroundKawasaki disease (KD) is an acute, febrile, systemic vasculitis of unknown etiology that primarily affects the coronary arteries and generally occurs at around 1 year of age. Although the diagnosis of KD is generally not difficult, it is challenging in cases of incomplete KD lacking characteristic clinical manifestations. The incidence of incomplete KD is higher in infants younger than 6 months of age. Pneumonia is an extremely rare complication of KD and can be misinterpreted as atypical pneumonia rather than KD. Herein, we report a neonate with atypical KD and severe pneumonia who required mechanical ventilation.Case presentationJapanese one-month-old infant had only fever and rash on admission (day 1), and he was transferred to the intensive care unit for severe pneumonia on day 2. Although pneumonia improved following intensive care, he was diagnosed with KD on day 14 because of emerging typical clinical manifestations such as fever, bulbar nonexudative conjunctival injection, desquamation of the fingers, and coronary artery aneurysm. KD symptoms improved after three doses of intravenous immunoglobulin plus cyclosporine. However, small coronary aneurysms were present at the time of discharge. In a retrospective analysis, no pathogens were detected by multiplex real-time PCR in samples collected at admission, and the serum cytokine profile demonstrated prominent elevation of IL-6 as well as elevation of neopterin, sTNF-RI, and sTNF-RII, which suggested KD.ConclusionsThe patient’s entire clinical course, including the severe pneumonia, was caused by KD. As in this case, neonatal KD may exhibit atypical manifestations such as severe pneumonia requiring mechanical ventilation.

Longitudinal Assessment of Cardiac Outcomes of Multisystem Inflammatory Syndrome in Children Associated With COVID-19 Infections.

BackgroundIn multisystem inflammatory syndrome in children, there is paucity of longitudinal data on cardiac outcomes. We analyzed cardiac outcomes 3 to 4 months after initial presentation using echocardiography and cardiac magnetic resonance imaging.Methods and ResultsWe included 60 controls and 60 cases of multisystem inflammatory syndrome in children. Conventional echocardiograms and deformation parameters were analyzed at 4 time points: (1) acute phase (n=60), (2) subacute phase (n=50; median, 3 days after initial echocardiography), (3) 1‐month follow‐up (n=39; median, 22 days), and (4) 3‐ to 4‐month follow‐up (n=25; median, 91 days). Fourteen consecutive cardiac magnetic resonance imaging studies were reviewed for myocardial edema or fibrosis during subacute (n=5) and follow‐up (n=9) stages. In acute phase, myocardial injury was defined as troponin‐I level ≥0.09 ng/mL (>3 times normal) or brain‐type natriuretic peptide >800 pg/mL. All deformation parameters, including left ventricular global longitudinal strain, peak left atrial strain, longitudinal early diastolic strain rate, and right ventricular free wall strain, recovered quickly within the first week, followed by continued improvement and complete normalization by 3 months. Median time to normalization of both global longitudinal strain and left atrial strain was 6 days (95% CI, 3–9 days). Myocardial injury at presentation (70% of multisystem inflammatory syndrome in children cases) did not affect short‐term outcomes. Four patients (7%) had small coronary aneurysms at presentation, all of which resolved. Only 1 of 9 patients had residual edema but no fibrosis by cardiac magnetic resonance imaging.ConclusionsOur short‐term study suggests that functional recovery and coronary outcomes are good in multisystem inflammatory syndrome in children. Use of sensitive deformation parameters provides further reassurance that there is no persistent subclinical dysfunction after 3 months.

Diagnosis and follow-up of patients with Kawasaki disease complicating coronary aneurysms by echocardiography: experience of 338 cases from a single center

Objective To investigate the diagnosis and prognosis of patients with coronary artery aneurysm in Kawasaki disease. Methods The data of ultrasonic diagnosis and follow-up of 338 children with Kawasaki disease complicated with coronary artery aneurysms were analyzed. Results The incidence of coronary artery aneurysm in the acute stage of Kawasaki disease was 21.2%(338/1 594). Of all the 338 cases, small aneurysms was 66.6%(225 cases), medium aneurysms was 25.1%(85 cases), and giant aneurysms was 8.3%(28 cases). There were 719 branches involved in 338 cases, 32.8% of them in left main coronary artery and 31.1% in right coronary artery; 25.3% in left anterior descending branch, and 10.8% in left circumflex branch. A total of 382 branches were followed up, including 218 branches of small coronary aneurysm group and 82.1% of them were completely recovered to the normal diameter. The medium aneurysm group was 124 brunches, the proportion of no significant change, retraction, and normal were 23.4%, 68.5% and 8.1%, respectively. There were 40 brunches in the giant anuerysm group, in which the proportion of no significant change, retraction, and normal were 70.0%, 27.5% and 2.5%, respectively. A total of 30 thrombosiswere detected by echocardiography in the acute stage, 20 thrombosis were regularly followed up, 12 thrombosis gradually subsided, and the other remained persist. Five thrombosis were detected in the sequelae stage, and all located in the giant coronary aneurysm. Seven children were clinically diagnosed with ischemic heart disease, of them, acute myocardial infarction in 1 case, 1 died of heart failure. Conclusions Kawasaki disease coronary artery disease are common in small coronary aneurysms, of which the left main artery and right coronary artery lesions are the most common, and the prognosis is better; medium and giant aneurysm need more time to recovery , and are easy to complicated with thrombosis. Key words: Echocardiography; Mucocutaneous lymph node syndrome; Coronary aneurysm

TCTAP C-014 Left Main Trunk Myocardial Infarction with Small Coronary Aneurysm at Just Proximal of Left Descending Artery

### Patient initials or identifier number MK ### Relevant clinical history and physical exam A 40-year-old male. He had no past medical history. He called for an ambulance because of chest pain. He was clear and alert at the time of contact by ambulance team. On the way to our hospital, he felt

Effects of Intravenous Gammmaglobulin Therapy Combined with Dexamethasone for the Initial Treatment of Acute Kawasaki Disease

We studied effects of intravenous gammmaglobulin therapy (IVGG) combined with dexamethasone (DEX) for the initial treatment of acute Kawasaki disease(KD). Prospectively studied 33 KD patients received total of 2g/kg IVGG for consecutive 4-5days plus 0.3mg/kg DEX for consecutive 3days (group 1). Retrospectively studied 33 KD patients received standard IVGG therapy (2g/kg IVGG for consecutive 4-5days)(group 2) were compared to analyze the efficacy and safety of the new regimen. There were no differences in age, sex, body weight, duration of illness, or given doses of gammmaglobulin between those two groups. Clinical no responders to the initial treatment received additive IVGG treatment. Informed consent was obtained from children's parents before therapy. No serious adverse effect was noted in both groups. The duration of high fever after the start of initial treatment in group1(1-12 days) was shorter than in group 2 (1-16 days)(p=0.07, by Mann-Whitney U-test). Two patients in group 1 and two patients in group 2 developed small coronary aneurysms. Although further analysis using larger numbers of patients are necessary to confirm the efficacy of this new regimen, we preriminaly demonstrated that IVGG combined with DEX in the initial treatment of acute KD was safe and may shorten the duration of fever.

Complications cardiovasculaires du syndrome de Kawasaki : résultats d’une enquête cardiopédiatrique multicentrique française

Patients and methods. – Between March 1, 1995 and February 29, 1996, a multicentric prospective study was conducted in France in order to analyze the cardiovascular complications in Kawasaki syndrome, and to describe the echocardiographic features and the outcome of coronary lesions. Forty-nine cases of Kawasaki syndrome were observed. Results. – There were 32 boys and 17 girls (sex ratio: 1:9). The age at diagnosis was under one year in ten cases (20.4%), between one and five years in 27 cases (55.1%) and more than five years in 12 cases (24.5%). The complete diagnostic criteria were present in 42 cases (85.1%). Forty-five children (91.8%) were given intravenous immunoglobulin treatment but only 20 (40.8%) received this treatment within the seven days following the onset of the illness. Cardiovascular complications consisted of: pericardial effusion in 12 cases (24.5%), coronary dilation in seven cases (14.3%), coronary aneurysms of moderate size in seven cases (14.3%,) with hypokinetic left ventricle in two cases. No death was reported. All patients with coronary dilation and four patients with coronary aneurysms had a normal size of coronary arteries at echocardiography within the nine months of the follow-up. Among the three other patients, after a follow-up of two years, one still has a small coronary aneurysm and two have a normal size of coronary arteries. Conclusion. – Despite a delayed administration of immunoglobulin therapy in the majority of patients in this study, outcome of coronary lesions was favorable and severe cardiac complications were rare in the acute phase of the Kawasaki syndrome.