Long-term follow up the clinical outcome of Kawasaki disease patients with Giant Coronary Aneurysms

  • Dr Takashi Higaki, Department of Pediatric Cardiology, Stroke & Cardiovascular Center Ehime University Hospital, Japan
  • Dr Eiichi Yamamoto, Department of Pediatric Cardiology, Stroke & Cardiovascular Center Ehime University Hospital, Japan
  • Dr Yoshitaka Murakami, Department of Pediatrics, Ehime University Graduate School of Medicine, Japan
  • Dr Osamu Matsuda, Department of Pediatrics, Ehime University Graduate School of Medicine, Japan
  • Dr Kyoko Konishi, Department of Pediatrics, Ehime University Graduate School of Medicine, Japan
  • Dr Koji Nagatani, Department of Pediatrics, Ehime University Graduate School of Medicine, Japan
  • Dr Mitsugi Nagashima, Department of Cardiovascular Surgery, Stroke & Cardiovascular Center Ehime University Hospital, Japan
  • Dr Eiichi Ishii, Department of Pediatrics, Ehime University Graduate School of Medicine, Japan

    • Background: The incidence of coronary artery involvement has markedly fallen following early gamma-globulin administration in Kawasaki disease (KD). Nevertheless coronary involvement may still occur and giant coronary aneurysms (GA) over 8 mm in diameter are more likely to lead to myocardial ischemia. However, long term cardiovascular complications and therapeutic strategy of KD with GA does not still remain well-known. Therefore, we retrospectively investigated the clinical outcome of KD patients with GA.
    Patients and Methods: Between 1977 and 2008, we studied 27 patients with 53 branches. Patients' ages ranged from 4 to 31 years old and ages at onset ranged from 0.2 to 8.7years old. All of the patients with GA were received a combination of low-dose aspirin and warfarin.
    Results: 10 patients had no stenotic lesion and 10 patients were complicated with stenosis or spontaneous recanalization. In 5 patients, aneurysm-size decreased gradually without stenosis, and In 2 patients, coronary aneurysms completely regressed which confirmed by coronary angiography.
    Four patients complicated acute thrombotic occlusion of coronary aneurysms. One had sudden death, one had acute myocardial infarction, one had angina pectoris and the other was silent. The age of three in these 4 patients were over 20 years old, and two of them had no stenosis under strict control of warfarin.
    Conclusion: To prevent coronary thrombosis, additional treatment may be needed in adult period even though having no stenosis. All patients who develop GA require diligent long-term review and re-consideration of therapeutic strategy.