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Case Report: Structural Changes in the Coronary Vessel Wall in a Patient With Incomplete Kawasaki Disease
Takamichi Ishikawa1, Hiroki Uchiyama1, Satoshi Mogi2
1Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Insights
Optical coherence tomography (OCT) revealed coronary artery wall changes in a patient with incomplete Kawasaki disease (KD) without aneurysms. This highlights OCT
Area of Science:
- Cardiovascular Imaging
- Pediatric Rheumatology
- Vascular Biology
Background:
- Kawasaki disease (KD) is a pediatric vasculitis affecting medium-sized vessels, posing risks for coronary artery lesions (CAL).
- Conventional imaging like cardiac catheterization has limitations in visualizing detailed coronary artery anatomy.
- Optical coherence tomography (OCT) offers high-resolution intracoronary imaging, distinguishing coronary arterial wall layers.
Observation:
- A case report details an 11-year-old girl with incomplete KD without coronary artery aneurysms.
- The patient did not receive intravenous immunoglobulin (IVIG) due to not meeting treatment criteria.
- Transthoracic echocardiography showed no dilatation or aneurysms; cardiac catheterization and angiography confirmed no significant coronary artery abnormalities.
Findings:
- Optical coherence tomography (OCT) revealed intimal thickening, media disruption, and neovascularization in the left anterior descending artery.
- These findings represent structural changes in the coronary artery wall.
- Coronary artery abnormalities were detected by OCT despite the absence of aneurysms or dilatation on conventional imaging.
Implications:
- OCT can detect subclinical coronary artery structural changes in incomplete Kawasaki disease, even without aneurysms.
- This imaging modality may be valuable for evaluating patients with incomplete KD who do not receive IVIG treatment.
- OCT provides insights into vascular remodeling in KD, aiding in understanding long-term cardiovascular risks.
Background:
Kawasaki disease (KD) is an acute systemic vasculitis of infants and young children that affects medium-sized vessels. Conventional cardiac imaging techniques, such as cardiac catheterization, are useful for characterizing the coronary arterial lesion (CAL) size and luminal diameter of the diseased coronary artery segment in patients with KD, but there are limitations to the visualization of the detailed vascular anatomy. Optical coherence tomography (OCT) is a high-resolution intracoronary arterial imaging modality that can distinguish the three layers of the coronary arterial wall. Several studies have reported coronary artery wall abnormalities in KD patients with coronary arterial aneurysm or regressed aneurysm. However, there have been no reports on changes in the coronary artery wall in cases of incomplete KD without CAL.
Case Presentation:
We herein report an 11-year-old girl with a history of incomplete KD without coronary arterial aneurysms. She had been diagnosed with perimembranous ventricular septal defect (VSD) after birth and had experienced incomplete KD at 1 year old. During her hospitalization for KD, she did not receive intravenous immunoglobulin (IVIG), because she did not meet the Harada score or criteria for treatment in patients with incomplete KD established by the American Heart Association. No dilatation or coronary artery aneurysm were observed on transthoracic echocardiography in the acute or follow-up period. At 11 years old, she received cardiac catheterization and coronary angiography (CAG) for the evaluation of a VSD and follow-up of KD. CAG demonstrated no aneurysm, dilatation, or significant stenosis of the coronary arteries. We performed an OCT study, which revealed the presence of intimal thickening, disruption of the media, and neovascularization in the left anterior descending artery.
Conclusion:
OCT demonstrates the structural changes of CA even in the patient with incomplete KD who have not been treated with IVIG.
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