Kawasaki disease: multiple giant coronary aneurysms intervention and pacemaker implantation due to complete heart...

Area of Science:

• Pediatrics
• Cardiology
• Immunology

Background:

• Kawasaki disease (KD) requires early intravenous immunoglobulin (IVIG) to prevent coronary artery aneurysms (CAAs).
• Delayed diagnosis or atypical presentations, common in rural areas, increase complication risk.
• Effective management of giant CAAs compromising cardiac function remains challenging.

Observation:

• A 19-month-old girl presented with atypical symptoms, leading to delayed KD diagnosis and IVIG treatment.
• She developed multivessel giant CAAs (>8 mm), acute myocardial infarction, and complete heart block.
• Percutaneous coronary intervention (PCI) was unsuccessful in restoring flow to the affected coronary artery.

Findings:

• Despite late IVIG, the patient experienced severe cardiac complications, including giant CAAs and myocardial infarction.
• Persistent bradycardia necessitated permanent pacemaker implantation.
• The patient demonstrated clinical stability at 12-month follow-up post-pacemaker insertion.

Implications:

• This case underscores the critical need for timely KD diagnosis and treatment, especially in atypical or remote cases.
• It highlights the limitations of standard treatments in managing severe, giant CAAs and associated cardiac dysfunction.
• The successful management with a pacemaker suggests a viable option for long-term cardiac support in such complex pediatric cases.