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7 results

  • An infant case of coronary artery aneurysms with no systemic symptoms after treatment for Kawasaki disease

  • Yumiko Asai, Takanori Suzuki, Midori Yamada
  • Journal:
    Cardiology in the Young , First View
    Published online by Cambridge University Press:
    05 November 2024, pp. 1-3
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  • This case is a 4-month-old patient with Kawasaki disease who showed coronary artery lesions after a disease relapse. Following the guidelines from the Randomised Controlled Trial to Assess Immunoglobulin plus Steroid Efficacy, the patient initially saw an improvement in symptoms. However, a relapse occurred despite low levels of C-reactive protein, leading to significant coronary artery growth. Treatment with a third dose of intravenous immunoglobulin and cyclosporine led to a slow reduction in the size of the coronary artery abnormalities. This case highlights the difficulty in monitoring Kawasaki disease progression through clinical symptoms and C-reactive protein levels alone. We also emphasise the necessity of echocardiographic monitoring in patients receiving anti-inflammatory treatments, including steroids, because coronary artery problems can arise or continue without the usual signs of Kawasaki disease or increased C-reactive protein levels.

  • Association of steroid administration with larger coronary artery abnormalities in patients with Kawasaki disease

  • Takanori Suzuki, Satoru Kawai, Eiji Morihana, Shinji Kawabe, Naomi Iwata, Kazuyoshi Saito, Tetsushi Yoshikawa, Kazushi Yasuda
  • Journal:
    Cardiology in the Young / Volume 33 / Issue 7 / July 2023
    Published online by Cambridge University Press:
    14 July 2022, pp. 1112-1116
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  • We sought to elucidate the risk profiles of patients with Kawasaki disease who developed coronary artery abnormalities through a retrospective analysis with special reference to steroid treatment. Demographics of the patients were obtained from medical records, and characteristics of the coronary artery abnormalities were evaluated by echocardiography and coronary angiography, which included number, location, size, and length of coronary artery abnormalities (we evaluated by cardiac catheterisation with the American Heart Association classification with segments). We divided the patients into two groups based on steroid use and compared their characteristics and the complications of coronary artery abnormalities and cardiac events. A total of 29 patients were diagnosed with coronary artery abnormalities by echocardiography and coronary angiography during the study period (24 male; median age, 24 months [range: 2–84 months]). Eighteen patients were treated with aspirin and intravenous immunoglobulin (63%, non-steroid group), whereas 11 received aspirin and intravenous immunoglobulin plus steroids (37%, steroid group). No significant differences were found in the number and location of coronary artery abnormalities between the steroid and non-steroid groups. However, the size and number of segments for coronary artery abnormalities were significantly larger and shorter, respectively, in the steroid group (z-score: non-steroid group 6.3 versus steroid group 8.7; p < 0.01). The coronary artery abnormality segments under steroid use were also shorter (non-steroid group versus steroid group, two segments versus one segment; p = 0.02). Coronary artery abnormality size was larger in patients who used steroids than that of non-steroids. This study showed that steroid use significantly affected coronary artery abnormality size in patients with Kawasaki disease. However, cardiac complications from coronary artery abnormalities and cardiac events were comparable between the steroid and non-steroid groups. Further prospective, multicentre studies are needed to confirm these findings.

  • Chapter 46 - Kawasaki Disease

  • from Section 7 - Miscellaneous Lesions and Syndromes
  • Edited by Laura K. Berenstain, James P. Spaeth
  • Book:
    Congenital Cardiac Anesthesia
    Published online:
    09 September 2021
    Print publication:
    16 September 2021, pp 352-358

  • Summary

    Kawasaki disease is a generalized vasculitis of unknown etiology affecting children. Although self-limited in most cases, the disease can cause coronary artery abnormalities, including coronary aneurysms. These are more frequently seen in untreated children but can also occur in those who received appropriate therapy at the time of diagnosis. The coronary artery abnormalities can resolve or persist. Those that persist can lead to coronary stenosis, thrombotic occlusion, or rarely, rupture, resulting in myocardial infarction, the primary cause of death in these children. Affected patients require close follow up for cardiac surveillance, which frequently involves the need for advanced cardiovascular imaging studies. Given their young age, sedation or general anesthesia is required in most cases. Management requires a thorough understanding of the pathophysiology of the disease process, particularly the cardiac manifestations of the condition, along with knowledge of the effects of the various anesthetic agents on hemodynamics and ventricular function.

  • Coronary arterial abnormalities detected in children over 10 years following initial Kawasaki disease using cardiac computed tomography

  • Part of
  • Rajkumar Chakraborty, Manphool Singhal, Vignesh Pandiarajan, Avinash Sharma, Rakesh K. Pilania, Surjit Singh
  • Journal:
    Cardiology in the Young / Volume 31 / Issue 6 / June 2021
    Published online by Cambridge University Press:
    28 January 2021, pp. 998-1002
  • Objective:

    To evaluate whether Kawasaki disease predisposes to premature atherosclerosis and to assess status of coronary artery abnormalities at least 10 years after diagnosis.

    Material and methods:

    A prospective study was carried out on 21 patients who were diagnosed with Kawasaki disease at least 10 years back and are on regular follow-up. The study was conducted on 128 Slice Dual Source computed tomography scanner with electrocardiography-triggered radiation optimised protocols for assessment of coronary artery abnormalities and calcifications.

    Results:

    Study cohort had 21 subjects – 15 males and 6 females (age range: 11–23 years; mean: 15.76 + 3.72 years). Mean age at time of diagnosis was 3.21 + 2.48 years. Mean time interval from diagnosis of Kawasaki disease to computed tomography coronary angiography was 12.59 + 2.89 years. Four children had evidence of coronary artery abnormalities on transthoracic echocardiography at time of diagnosis. Of these, two had persistent abnormalities on computed tomography coronary angiography. One subject (4.76%) had coronary calcification that was localised to abnormal coronary artery segment. Four coronary artery abnormalities (one saccular; three fusiform aneurysms) were noted in two subjects.

    Conclusion:

    Prevalence of coronary artery calcification is low and, if present, is localised to abnormal segments. This calcification is likely dystrophic rather than atherosclerotic. It appears that coronary artery abnormalities can persist for several years after acute episode of Kawasaki disease. Periodic follow-up by computed tomography coronary angiography is now a feasible non-invasive imaging modality for long term surveillance of patients with Kawasaki disease who had coronary artery abnormalities at time of diagnosis.

  • Relationship between mean platelet volume-to-lymphocyte ratio and coronary artery abnormalities in Kawasaki disease

  • Gulcin Bozlu, Derya Karpuz, Olgu Hallioglu, Selma Unal, Necdet Kuyucu
  • Journal:
    Cardiology in the Young / Volume 28 / Issue 6 / June 2018
    Published online by Cambridge University Press:
    16 April 2018, pp. 832-836
  • Objectives

    Recently, mean platelet volume-to-lymphocyte ratio has emerged as a novel parameter of inflammation. No study has investigated the role of mean platelet volume-to-lymphocyte ratio in children with Kawasaki disease. We aimed to evaluate the relationship between mean platelet volume-to-lymphocyte ratio and coronary artery abnormalities in Kawasaki disease.

    Methods

    Between January 2008 and January 2017, a total of 58 children with Kawasaki disease and 42 healthy subjects matched for sex and age were enrolled. Before the treatment, transthoracic echocardiography for all children was performed. Clinical and laboratory results including mean platelet volume, platelet distribution width, red blood cell distribution width, and counts of platelets, neutrophils, lymphocytes, and white blood cells, erythrocyte sedimentation rate, and C-reactive protein levels were measured. Mean platelet volume-to-lymphocyte ratio was calculated as mean platelet volume divided by lymphocyte count.

    Results

    Compared with healthy controls, mean platelet volume-to-lymphocyte ratio was significantly lower in the children with Kawasaki disease (p<0.01). A total of 14 patients (24.1%) had incomplete Kawasaki disease and 15 (25.8%) children with Kawasaki disease had coronary involvement. Mean platelet volume-to-lymphocyte ratio was significantly lower in patients with coronary artery abnormalities (p<0.01). According to receiver operating characteristic curve analysis performed for the prediction of coronary artery abnormalities, the best cut-off point for mean platelet volume-to-lymphocyte ratio was 2.5 (area under curve=0.593, sensitivity 53.3%, specificity 51.1%).

    Conclusion

    It was first shown that the children with Kawasaki disease have lower mean platelet volume-to-lymphocyte ratio compared with control subjects. Mean platelet volume-to-lymphocyte ratio may be helpful in predicting coronary artery lesions in patients with Kawasaki disease.