[Six Kawasaki disease patients with acute coronary artery thrombosis]
Shu-lai Zhou1, Jian-ping Luo1, Yan-qi Qi1
1Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Insights
Acute coronary artery thrombosis in Kawasaki disease (KD) often affects the left anterior descending artery and carries a risk of sudden cardiac death. Early recognition and treatment are crucial for improving outcomes in affected children.
Area of Science:
- Cardiology
- Pediatrics
- Rheumatology
Context:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Coronary artery abnormalities, including thrombosis, are serious complications of KD.
- Understanding the patterns and outcomes of coronary artery thrombosis in KD is vital for clinical management.
Purpose:
- To enhance awareness of acute coronary artery thrombosis in pediatric patients diagnosed with Kawasaki disease.
- To retrospectively analyze clinical data, including manifestations, laboratory findings, and treatment outcomes of KD patients with coronary artery thrombosis.
Summary:
- Six pediatric patients with Kawasaki disease and acute coronary artery thrombosis were studied.
- Thrombosis predominantly occurred in the left anterior descending artery.
- Thrombolytic therapy showed variable success, with one patient experiencing fatal myocardial infarction.
Impact:
- Highlights the significant risk of myocardial infarction and sudden death in KD patients with coronary artery thrombosis.
- Emphasizes the need for vigilant monitoring and prompt intervention for coronary artery thrombosis in Kawasaki disease.
- Informs clinical practice regarding the management of this rare but severe complication of KD.
Objective:
To improve the awareness of acute coronary artery thrombosis in Kawasaki disease (KD).
Method:
Six KD patients with acute coronary artery thrombosis (Jan. 2004 to Jan. 2013) were studied retrospectively. The basic information, clinical manifestations, laboratory data, echocardiography and electrocardiography (ECG), method and consequence of thrombolytic therapy were analyzed.
Result:
The mean age of patients with coronary artery thrombosis (5 males and 1 female) was (17.2 ± 11.3) months.Five cases had thrombosis in left coronary artery (LCA), and four cases had thrombosis in aneurysm of left anterior descending artery (LAD). One case had thrombosis in both left and right coronary artery (RCA).One case died. Maximum thrombus was about 1.60 cm × 0.80 cm, locating in LAD. The diameter of LCA and RCA was (0.44 ± 0.07) cm and (0.45 ± 0.07) cm. Two patients showed abnormal ECG. Case 3 showed ST segment depression in lead V5. Case 6 showed myocardial infarction.In acute phase of KD, three patients received treatment with intravenous immunoglobin (IVIG), five patients were treated with aspirin.In sub-acute and convalescent phase of KD, all patients were treated with low-dose aspirin.Warfarin and dipyridamole were applied in 5 patients. All cases were treated with thrombolytic therapy using urokinase and/or heparin. After thrombolytic therapy, echocardiography showed thrombolysis in four cases and no change in one.One patient died of myocardial infarction.
Conclusion:
Most of acute coronary thrombosis in KD occurred in LAD. KD patients with coronary artery thrombosis are at risk of sudden death due to myocardial infarction.
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