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High incidence of aortic regurgitation following Kawasaki disease
Insights
Kawasaki disease can cause aortic regurgitation, a significant heart complication. This study found 4.6% of patients had this condition, often linked to coronary artery aneurysms.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Rheumatology
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Carditis is a common complication, potentially leading to valvular issues.
- Aortic regurgitation's prevalence and significance in Kawasaki disease require further elucidation.
Purpose of the Study:
- To determine the incidence of aortic regurgitation in patients with Kawasaki disease.
- To characterize the clinical presentation and diagnostic findings associated with aortic regurgitation in this cohort.
- To assess the natural history and echocardiographic findings of aortic regurgitation over one year.
Main Methods:
- Retrospective analysis of 131 patients with Kawasaki disease undergoing cardiac examinations between December 1979 and July 1984.
- Aortography was used to document aortic regurgitation.
- Clinical examination, chest roentgenograms, ECG, and echocardiography were employed for assessment.
Main Results:
- Aortic regurgitation was documented in 4.6% (6/131) of patients via aortography.
- A protodiastolic murmur was heard in 4 patients; cardiac enlargement and LVH were inconsistently observed.
- Of 5 patients with repeat angiography after 1 year, 2 resolved AR; 3 showed persistent AR on echocardiography.
- All patients with AR had associated coronary artery aneurysms; 2 developed myocardial infarction.
Conclusions:
- Aortic regurgitation is a notable cardiovascular complication of Kawasaki disease, not as rare as previously thought.
- The development of AR is likely linked to carditis during the acute phase of Kawasaki disease.
- Associated coronary artery aneurysms and potential for myocardial infarction highlight the severity of cardiovascular involvement.
Abstract:
Among 131 patients with Kawasaki disease who underwent cardiac examinations from December 1979 to July 1984, six (4.6%) had aortic regurgitation documented on aortography. A protodiastolic murmur typical of aortic regurgitation was heard in four patients. Both cardiac enlargement on chest roentgenogram and ECG signs of left ventricular hypertrophy were demonstrated in only half of the patients. Of five patients who underwent a second angiographic study 1 year later, two no longer had aortic regurgitation; pulsed Doppled echocardiography at this point revealed aortic regurgitant flow in the remaining three patients. All patients had associated coronary artery aneurysms, and two patients developed subsequent myocardial infarction. The development of aortic regurgitation following Kawasaki disease has been considered to be causally related to the carditis that most frequently occurs during the acute stage of the illness. Our data indicate that aortic regurgitation is not rare but is an important additional cardiovascular complication of Kawasaki disease.