Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-19T03:52:39.915Z Has data issue: false hasContentIssue false
  • English
  • Français

Biopsy-proven myocardial sequels in Kawasaki disease with giant coronary aneurysms

Published online by Cambridge University Press:  28 June 2010

Susumu Yonesaka ,
Toru Takahashi ,
Shuji Eto ,
Takumi Sato ,
Katuki Otani ,
Tomomi Ueda ,
Akira Sato ,
Yosuke Kitagawa ,
Yuki Konno  and
Manabu Kinjo
Susumu Yonesaka*
Affiliation:
Department of Nursing, School of Health Sciences, Hirosaki University, 66-1 Honcho, Hirosaki, Japan
Toru Takahashi
Affiliation:
Department of Pediatrics, School of Medicine, Hirosaki University, 5-Zaifucho, Hirosaki, Japan
Shuji Eto
Affiliation:
Department of Pediatrics, School of Medicine, Hirosaki University, 5-Zaifucho, Hirosaki, Japan
Takumi Sato
Affiliation:
Department of Pediatrics, School of Medicine, Hirosaki University, 5-Zaifucho, Hirosaki, Japan
Katuki Otani
Affiliation:
Department of Pediatrics, School of Medicine, Hirosaki University, 5-Zaifucho, Hirosaki, Japan
Tomomi Ueda
Affiliation:
Department of Pediatrics, School of Medicine, Hirosaki University, 5-Zaifucho, Hirosaki, Japan
Akira Sato
Affiliation:
Department of Pediatrics, School of Medicine, Hirosaki University, 5-Zaifucho, Hirosaki, Japan
Yosuke Kitagawa
Affiliation:
Department of Pediatrics, School of Medicine, Hirosaki University, 5-Zaifucho, Hirosaki, Japan
Yuki Konno
Affiliation:
Department of Pediatrics, School of Medicine, Hirosaki University, 5-Zaifucho, Hirosaki, Japan
Manabu Kinjo
Affiliation:
Department of Pediatrics, School of Medicine, Hirosaki University, 5-Zaifucho, Hirosaki, Japan
*
Correspondence to: S. Yonesaka, Department of Nursing, School of Health Sciences, Hirosaki University, 66-1 Honcho, Hirosaki, 036-8564 Japan. Tel: +81 172 395947; Fax: +81 172 395947; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Although most Kawasaki disease with giant coronary aneurysms is asymptomatic, conventional investigations might not identify previous lesions, or all Kawasaki disease with giant aneurysms at risk of future myocardial lesions. We evaluated the long-term histopathology of the myocardium, especially of intramural small vessels in asymptomatic Kawasaki disease with giant aneurysms.

Method

The initial study comprised 16 consecutive Kawasaki patients – male-to-female ratio was 12:4 – aged from 2 to 12 years, and in the subsequent study, the same patients were aged from 4.9 to 16 years. Endomyocardial biopsies were histopathologically evaluated. Microangiopathies, mitochondrial abnormalities, and loss or disarray of myofibrils were compared by electron microscopy.

Results

The incidence of histopathological abnormalities such as degeneration, hypertrophy, and inflammatory cell infiltration was quite high in the initial study, and inflammatory cell infiltration, interstitial fibrosis, and disarray were very noticeable at follow-up biopsies. The area of fibrous tissue was significantly higher in patients administered with intravenous immunoglobulin at follow-up biopsies. Electron microscopy showed microangiopathies including microthrombi within intramural small vessels in some patients at follow-up biopsies. The sites of the coronary aneurysms did not seem to have an impact on the biopsy findings, suggesting that the underlying pathophysiology is related to the original disease process.

Conclusions

Whether the abnormalities were due to direct myocardial injury, chronic ischaemia, repeated small-vessel thrombosis, or other problems associated only with biopsies, is difficult to determine. However, this subgroup had residual abnormal lesions in the myocardium. Follow-up should be more aggressive in this group of patients to identify myocardial damage that could be asymptomatic.

Keywords

Acquired cardiac diseasecoronary arterial lesionendomyocardial biopsycardiomyopathy
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 6 , December 2010 , pp. 602 - 609
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Iemura, M, Ishii, M, Sugimura, T, Akagi, T, Kato, H. Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function. Heart 2000; 83: 307–311.Google Scholar
2. Ishii, M, Ueno, T, Ikeda, H, et al. Sequential follow-up results of catheter intervention for coronary artery lesions after Kawasaki disease: quantitative coronary artery angiography and intravascular ultrasound imaging study. Circulation 2002; 105: 3004–3010.CrossRefGoogle ScholarPubMed
3. Suzuki, A, Kamiya, T, Arakaki, Y, Kinoshita, Y, Kimura, K. Fate of coronary arterial aneurysms in Kawasaki disease. Am J Cardiol 1994; 74: 822–824.Google Scholar
4. Yonesaka, S, Takahashi, T, Matubara, T, et al. Histopathological study on Kawasaki disease with special reference to the relation between the myocardial sequelae and regional wall motion abnormalities of the left ventricle. Jpn Circ J 1992; 56: 352–358.CrossRefGoogle Scholar
5. Yutani, C, Okano, K, Kamiya, T, et al. Histopathological study on right endomyocardial biopsy of Kawasaki disease. Br Heart J 1980; 43: 589–592.CrossRefGoogle Scholar
6. Kawasaki, T. Kawasaki disease. Nippon Rinsho 2001; 59 (Suppl 8): 823–832; (in Japanese).Google ScholarPubMed
7. Sekiguchi, M, Hiroe, M, Moritomo, S. On the standardization of histopathological diagnosis and semiquantitative assessment of the endocardium obtained by endomyocardial biopsy. Bull Heart Inst Jpn 1979–1980; 20: 55–85.Google Scholar
8. Yonesaka, S, Becker, AE. Dilated cardiomyopathy: diagnostic accuracy of endomyocardial biopsy. Br Heart J 1987; 58: 156–161.CrossRefGoogle ScholarPubMed
9. Yonesaka, S, Takahashi, T, Furukawa, H, et al. Histopathological analysis of myocardial damages following Kawasaki disease with repeated endomyocardial biopsy. Kokyu To Junkan 1992; 40: 375–381.Google Scholar
10. Yutani, C, Go, S, Kamiya, T, et al. Cardiac biopsy of Kawasaki disease. Arch Pathol Lab Med 1981; 105: 470–473.Google Scholar
11. Haneda, N, Mori, C. Histopathologic and coronary angiographic assessment of effectiveness of aspirin or aspirin-and-gammaglobulin in Kawasaki disease. Acta Paediatr Jpn 1993; 35: 294–297.CrossRefGoogle ScholarPubMed
12. Mori, M, Tomono, N, Yokota, S. Coronary arteritis of Kawasaki disease unresponsive to high-dose intravenous gammaglobulin successfully treated with plasmapheresis. Nihon Rinsho Meneki Gakkai Kaishi 1995; 18: 282–288.Google Scholar
13. Liu, AM, Ghazizadeh, M, Onouchi, Z, Asano, G. Ultrastructural characteristics of myocardial and coronary microvascular lesions in Kawasaki disease. Microvasc Res 1999; 58: 10–27.CrossRefGoogle ScholarPubMed
14. Onouchi, Z, Hamaoka, K, Sakata, K, et al. Long-term changes in coronary artery aneurysms in patients with Kawasaki disease: comparison of therapeutic regimens. Circ J 2005; 69: 265–272.CrossRefGoogle ScholarPubMed
15. Takeuchi, M, Matsushita, T, Kurotobi, S, Sano, T, Kogaki, S, Ozono, K. Application of signal-averaged electrocardiogram to myocardial damage in the late stage of Kawasaki disease. Circ J 2006; 70: 1443–1445.CrossRefGoogle ScholarPubMed
16. Genma, Y, Ogawa, S, Zhang, J, Yamamoto, M. Evaluation of myocardial ischemia in Kawasaki disease by dobutamine stress signal-averaged ventricular late potentials. Cardiovasc Res 1997; 36: 323–329.CrossRefGoogle ScholarPubMed