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Changes in coronary perfusion after occlusion of coronary arteries in Kawasaki disease
Ji Hee Kwak1, Jinyoung Song, I-Seok Kang
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. amyjys@naver.com.
Insights
Kawasaki disease can lead to coronary artery occlusion in children. Careful follow-up of the right coronary artery is crucial due to potential changes in collaterals and new occlusions.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Kawasaki Disease
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Coronary artery aneurysms and occlusions are known complications.
- Myocardial infarction in this context is rare due to collateral circulation.
Purpose of the Study:
- To investigate changes in coronary perfusion in children with coronary artery occlusion post-Kawasaki disease.
- To understand the dynamics of collateral vessel development and regression.
Main Methods:
- Retrospective review of serial coronary angiographies in 11 children with coronary artery occlusion after Kawasaki disease.
- Analysis of changes in collateral vessel formation and regression over time.
Main Results:
- Total occlusions were observed in the left anterior descending and right coronary arteries.
- Recanalization of the left coronary artery led to collateral regression, while right coronary artery occlusion promoted new collateral development.
- In some cases, right coronary artery collaterals decreased without recanalization, even without clinical symptoms.
Conclusions:
- The right coronary artery requires vigilant monitoring due to the potential for new occlusions or alterations in collateral flow.
- Understanding collateral dynamics is key to managing coronary artery complications after Kawasaki disease.
Purpose:
Myocardial infarction in children with total occlusion of a coronary artery after Kawasaki disease is rare due to multiple collateral vessels. We aimed to investigate the changes in coronary perfusion associated with coronary artery occlusion after Kawasaki disease.
Materials And Methods:
Eleven patients with coronary artery occlusion after Kawasaki disease were investigated. Serial coronary angiographies after total occlusion of a coronary artery were reviewed and the changes were described in all patients with additive information collected.
Results:
The median age at the occlusion was 5.9 years old. The interval to occlusion was 6.2±6.9 years. Four left anterior descending coronary artery total occlusions and 10 right coronary artery total occlusions were detected. Immediate coronary artery bypass graft for left anterior descending coronary artery total occlusion made right coronary total occlusion occurred in all except one patient and the intervals thereof were 1 year, 1.8 years, and 4 years. Collaterals to the left coronary artery regressed after recanalization, while new collaterals to the right coronary artery developed. In three, collaterals to the right coronary artery decreased without recanalization without clinical signs.
Conclusion:
The right coronary artery should be followed up carefully because of possible occlusion of new onset or changes in collaterals.
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