A fatal case of ruptured giant coronary artery aneurysm

Area of Science:

• Pediatric Cardiology
• Rheumatology
• Vascular Medicine

Background:

• Kawasaki disease (KD) is a leading cause of acquired heart disease in children, often associated with coronary artery aneurysms (CAAs).
• While typically managed with intravenous immunoglobulin and aspirin, some KD cases progress to severe CAA complications.
• CAA rupture is a rare but catastrophic event, necessitating a deeper understanding of risk factors and management strategies.

Observation:

• A 5-year-old boy with KD developed bilateral CAAs, including a rapidly enlarging 18-mm left anterior descending artery aneurysm.
• Despite standard treatment with IV gamma globulin, aspirin, and anticoagulation, the aneurysm continued to expand.
• The patient experienced abrupt cardiac arrest due to a ruptured LAD aneurysm and cardiac tamponade, leading to death.

Findings:

• Microscopic examination of the ruptured aneurysm revealed significant neutrophilic infiltration, indicating active inflammation.
• The case underscores the potential for rapid, aggressive CAA progression even with conventional KD treatment.
• The study proposes a new classification of "super-giant" CAAs ( >10 mm with ongoing vasculitis) to identify high-risk cases.

Implications:

• Early identification and differentiation of "super-giant" CAAs are critical for timely intervention and improved patient survival.
• Aggressive management strategies, potentially including surgical intervention or intensive care, should be considered for "super-giant" CAAs.
• This case highlights the importance of vigilant monitoring and advanced management protocols for complex Kawasaki disease cases.