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[Cardiac complications in Kawasaki disease]
J Mares Bermúdez1, C Sánchez Ufarte, N Sanz Manrique
1Hospital Infantil Valla de Hebrón, Barcelona.
Insights
Kawasaki disease can cause coronary artery aneurysms, sometimes leading to myocardial infarction. Early detection and management are crucial for pediatric patients with this condition.
Area of Science:
- Pediatric Cardiology
- Rheumatology
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Coronary artery abnormalities are a significant complication.
Observation:
- Three pediatric patients diagnosed with Kawasaki disease presented with coronary artery involvement.
- Two patients developed coronary artery aneurysms within three weeks, with one resolving and another persisting.
- A third patient had a left coronary artery aneurysm and right coronary artery aneurysms, leading to myocardial infarction.
Findings:
- Two-dimensional echocardiography identified coronary artery involvement and aneurysms.
- Coronary angiography detected right coronary artery aneurysms missed by echocardiography.
- Electrocardiography and thallium scintigraphy confirmed myocardial infarction in one patient.
Implications:
- Coronary angiography is vital for detecting all coronary artery aneurysms.
- Coronary artery aneurysms without stenosis can progress to myocardial infarction.
- Further research is needed on the optimal timing and indications for coronary angiography in Kawasaki disease.
Abstract:
We present 3 patients, aged 7 and 12 months. and 5 years, who meet the diagnostic criteria for Kawasaki's disease. In these, there was coronary artery involvement. which was identified by two dimensional echocardiography. In two of these, a coronary artery involvement which was identified by two dimensional echocardiography. In two of these, a coronary artery aneurysm was demonstrated within the 3rd week. The aneurysm resolved after 4 months in one patient, and still persist after 15 months in the other. The third patient had a left coronary artery aneurysm, confirmed by angiocardiography, which also showed small aneurysms in the right coronary artery. The electrocardiographic study of this patient, performed 3 months after onset, showed a patterns of necrosis (anterolateral infarction), confirmed by mean of a thallium scintigraphy. We have performed a study about the management of this kind of patients, and can conclude: 1. Coronary angiocardiography may permit the detection of right coronary artery aneurysms, not visualized by echocardiography. 2. Patients with coronary artery aneurysms, with no stenotic lesions 1 the coronary angiocardiography, may evolve into myocardia infarction. 3. We expose our doubts about the indication and right time to perform the angiocardiographic study.