Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-23T00:01:20.874Z Has data issue: false hasContentIssue false
  • English
  • Français

Thrombolysis in the treatment of patients with Kawasaki disease

Published online by Cambridge University Press:  19 August 2008

Atsuko Suzuki ,
Kamiya Tetsuro ,
Yasuo Ono  and
Yoshihisa Kinoshita
Atsuko Suzuki*
Affiliation:
From the Department of Pediatrics, National Cardiovascular Center, Osaka
Kamiya Tetsuro
Affiliation:
From the Department of Pediatrics, National Cardiovascular Center, Osaka
Yasuo Ono
Affiliation:
From the Department of Pediatrics, National Cardiovascular Center, Osaka
Yoshihisa Kinoshita
Affiliation:
From the Department of Pediatrics, National Cardiovascular Center, Osaka
*
Dr. Atsuko Suzuki, Department of Pediatrics, National Cardiovascular Center, 5–7–1, Fujishirodai Suitashi, Osaka 565, Japan.
Get access Rights & Permissions [Opens in a new window]

Abstract

Thrombolysis was used in 13 procedures to treat eight patients with massive thrombosis of coronary aneurysms due to Kawasaki disease. The patients have now been followed for periods ranging from 2.5 years to 7.4 years subsequent to treatment. The procedures included intracoronary or intravenous infusion of urokinase and intravenous administration of tissue plasminogen activator. Thallium myocardial imaging, coronary arteriography and echocardiography were used for evaluation of the efficacy of the therapy and for follow-up studies. The latest time of treatment was 17 months after the onset of the disease. No new formation of massive thrombus was observed in any of the aneurysms. In five patients, eight of 13 procedures were judged to be successful. In the four patients with symptoms of myocardial ischemia, thrombolysis was undertaken immediately after the onset of symptoms. In the other patient, thrombolysis was attempted 36 days after the onset and produced remarkable improvement in the degree of ischemia. In the other four patients with no symptoms of ischemia, the therapy was undertaken when thrombus was detected in a coronary aneurysm. Aortocoronary bypass surgery was undertaken subsequent to the thrombolytic therapy in three patients, but proved satisfactory in only one patient. At follow-up, five patients have shown improvement in the degree of myocardial ischemia after treatment. Our results suggest that careful observation is needed to detect formations of thrombus in large coronary arteries for at least 1½ years after the onset of Kawasaki disease. Even if repeated thrombolytic therapy is required, it seems to be effective in checking the progression of ischemic heart disease.

Keywords

Kawasaki diseasethrombolysiscoronary arterycoronary aneurysm
Type
Original Articles
Information
Cardiology in the Young , Volume 3 , Issue 3 , July 1993 , pp. 207 - 215
Copyright
Copyright © Cambridge University Press 1993

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.Kato, H, Ichinose, E, Kawasaki, T. Myocardial infarction in Kawasaki disease. Clinical analysis in 195 cases. J Pediatr 1986; 108: 923–927.CrossRefGoogle ScholarPubMed
2.Suzuki, A, Kamiya, T, Ono, Y, Kohata, T, Okuno, M. Myocardial ischemia in Kawasaki disease: follow-up study by cardiac catheterization and coronary angiography. Pediatr Cardiol 1988; 9: 1–5.CrossRefGoogle ScholarPubMed
3.Kato, H, Ichinose, E, Inoue, O, Akagi, T. Intracoronary throm bolytic therapy in Kawasaki disease: treatment and prevention ofacute myocardial infarction. Kawasaki disease. Alan R. Liss, New York, 1987, pp 445–454.Google Scholar
4.Pombo, JF, Troy, BL, Russell, RO Jr. Left ventricular volumes and ejection fraction by echocardiography. Circulation 1971; 43: 480–490.CrossRefGoogle ScholarPubMed
5.Kawasaki disease research committee ofJapanese Ministry of Health and Welfare. Guideline oftreatment and management for the children with cardiovascular involvement due to Kawasaki disease. J Jpn Pediatr Soc 1986; 90: 1399–1401.Google Scholar
6.Shirahata, A, Nakamura, T, Ariyoshi, N. Blood coagulation status in patients beyond one year after the onset of Kawasaki disease. J Jpn Pediatr Soc 1990; 94: 2608–2613. [Japanese]Google Scholar
7.Suzuki, A, Kamiya, T. Visualization of the coronary arterial lesions in Kawasaki disease by coronary angiography. Cardiol Young 1991; 1: 225–233CrossRefGoogle Scholar
8.Nakano, H, Nojina, K, Saito, A, Ueda, K. Grading of dilated lesion due to Kawasaki disease based on the findings of coronary arteriography. J Jpn Pediatr Soc 1984; 88: 1275– 1282. [Japanese]Google Scholar
9.Kuroe, K, Kohata, T, Echigo, S, Suzuki, A, Kamiya, T, Naitou, H, Saitou, H, Takamiya, M. Myocardial imaging on ultrafast computed tomography in patients with a history of Kawasaki disease. Prog Med 1990; 10: 93–97. [Japanese]Google Scholar
10.Suzuki, A, Kamiya, T, Yasuo, Ono, Kenji, Kuroe, Kohji, Kimura. Long-term follow-up study of coronary arterial lesions in Kawasaki disease—time of appearance and progression of stenotic lesions. Acta Cardiol Paed Jpn 1992; 7: 653–658. [Japanese]Google Scholar