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A rare case: surviving acute left main coronary artery occlusion in Kawasaki's disease
P S Orrego1, A Pezzano, H Muriesan
1Servizio di Cardiologia Interventistica, Ospedale Niguarda Ca' Granda, Milano.
Insights
A patient with Kawasaki disease experienced cardiogenic shock from left main coronary artery blockage. Successful treatment involved angioplasty, bypass surgery, and ultimately heart transplantation, with the patient recovering well.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiovascular Surgery
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children, often leading to coronary artery aneurysms.
- Coronary artery aneurysms, particularly in the left main artery, pose a significant risk of thrombotic events and myocardial infarction.
- Cardiogenic shock is a life-threatening condition requiring immediate and aggressive management.
Observation:
- A case of cardiogenic shock in a patient with aneurysmal coronary artery disease secondary to Kawasaki disease is presented.
- The patient presented with acute thrombotic occlusion of the left main coronary artery.
- Persistent low-output syndrome was observed despite initial interventions.
Findings:
- Percutaneous transluminal coronary angioplasty (PTCA) was utilized as a bridge to coronary artery bypass grafting (CABG).
- Orthotopic heart transplantation was successfully performed three days post-CABG due to refractory low-output syndrome.
- The patient demonstrated a positive outcome, remaining alive and well one year after the heart transplant.
Implications:
- This case highlights the critical importance of vigilant monitoring and timely intervention in pediatric patients with Kawasaki disease and coronary aneurysms.
- Aggressive management strategies, including revascularization and advanced therapies like heart transplantation, may be necessary for life-threatening complications.
- Successful heart transplantation offers a viable long-term solution for end-stage heart failure resulting from Kawasaki disease-associated coronary artery pathology.
Abstract:
We present a case of cardiogenic shock due to acute thrombotic occlusion of the left main coronary artery in Kawasaki's aneurysmal coronary artery disease. The patient was treated with PTCA as a bridge to CABG. Because of a persistent low-output syndrome, orthotopic heart transplantation was successfully performed three days later. The patient is alive and well one year after the event.