[Cardiac involvement in Kawasaki disease. Our experience]
Related Experiment Videos
P Sciacca1, R Falsaperla, P Barone
1U. O. di Cardiologia Pediatrica, Università degli Studi, Catania, Italy. sciapie@hotmail.com
Insights
Early diagnosis and treatment for Kawasaki disease (KD) can prevent coronary artery anomalies. However, some children develop coronary issues despite timely intervention, highlighting the need for continued monitoring.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Vascular Biology
Background:
- Kawasaki disease (KD) is a critical pediatric vasculitis impacting children under five.
- Coronary artery anomalies (CAA) occur in 20-25% of KD cases, posing long-term risks.
- While early treatment with intravenous immunoglobulin and aspirin reduces CAA risk, some cases progress despite prompt management.
Purpose of the Study:
- To report clinical experience with Kawasaki disease in children.
- To evaluate the incidence and progression of coronary artery anomalies in treated KD patients.
- To emphasize the importance of ongoing follow-up for KD patients with CAA.
Main Methods:
- A cohort of 41 children diagnosed with Kawasaki disease was studied.
- Serial electrocardiography and echocardiography were performed at multiple intervals up to one year post-diagnosis.
- Long-term follow-up (6-9 years) was conducted for a subset of patients.
Main Results:
- Echocardiographic cardiac anomalies were identified in 12.19% of patients, with lower average age in affected children.
- Coronary involvement occurred despite early diagnosis and treatment.
- Coronary anomalies regressed in three cases within the first year; two remained under follow-up. Long-term outcomes were generally favorable, with rare instances of renal arteritis or mitral incompetence.
Conclusions:
- Clinical and instrumental follow-up is crucial for all Kawasaki disease patients with coronary anomalies.
- Extended monitoring is recommended even for cases where coronary anomalies initially regress.
Background:
Kawasaki disease is an acute vasculitis of unknown cause that affects children under 5 years of age and in 20-25% of cases can cause coronary artery anomalies. Early therapy with intravenous gamma globulin and aspirin greatly decreases the risk of developing coronary anomalies, but sometimes coronary disease develops even in timely diagnosed and treated cases.
Methods:
Personal experience in 41 children with Kawasaki disease is reported. Age was within three months and 5 years. All patients had electrocardiography and echocardiography at diagnosis, after 1 week, at the third, sixth, and eighth week, after six months and after 1 year from diagnosis. Echocardiographic cardiac anomalies were found only in 5 cases (12.19%). Average age in these cases was lower.
Results:
In these cases coronary involvement developed in spite of early diagnosis and therapy (intravenous gamma globulin 400 mg/kg die and aspirin) electrocardiographic findings were not relevant or specific to coronary arteries anomaly. In three cases coronary anomalies regressed during the first year from diagnosis, the other two are still in the first year of follow-up. Nine children had a long term follow-up (6 to 9 years) and they were all normal except one with renal arteritis and another with slight mitral incompetence.
Conclusions:
The authors underline the role of clinical and instrumental follow-up that should be extended to all patients affected by Kawasaki disease with coronary anomalies even if early regressed.
Related Concept Videos
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:23Rheumatic Heart Disease I: Introduction
01:21Myocarditis I: Introduction
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:21Rheumatic Heart Disease III: Medical Management