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[Valvular lesions complicating Kawasaki disease: a Doppler echocardiographic evaluation]
Insights
Kawasaki disease can cause heart valve problems like mitral, aortic, and tricuspid regurgitation. Doppler echocardiography is crucial for diagnosing these complications, which generally have a good prognosis.
Area of Science:
- Cardiology
- Pediatric Cardiology
Context:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Coronary artery aneurysms are the most common complication.
- Valvular disease is less frequently observed but significant.
Purpose:
- To investigate the incidence and characteristics of valvular heart disease in patients with Kawasaki disease.
- To evaluate the diagnostic utility of Doppler echocardiography for valvular complications.
- To assess the prognosis of valvular lesions in this population.
Summary:
- Mitral regurgitation (MR), aortic regurgitation (AR), and tricuspid regurgitation (TR) were observed in 7.3%, 4.6%, and 4.2% of patients, respectively.
- Doppler echocardiography confirmed all valvular diagnoses, proving more sensitive than physical examination or traditional imaging.
- Cardiomegaly and ECG findings of cardiac overload were associated with MR and AR, but not TR.
- Coronary artery aneurysms were present in most patients.
- Myocardial infarction occurred in some patients with MR and AR.
- Valvular lesions generally showed a good prognosis without progression to stenosis.
Impact:
- Highlights the importance of echocardiography in detecting subtle valvular dysfunction in Kawasaki disease.
- Provides data on the prevalence and natural history of valvular complications.
- Informs clinical management and follow-up strategies for pediatric patients with Kawasaki disease.
Abstract:
Coronary artery aneurysms are the most frequent and important complication of Kawasaki disease, but valvular disease is less frequently observed. During the last three years, we have observed mitral regurgitation (MR) in nine (7.3%), aortic regurgitation (AR) in six (4.6%) and tricuspid regurgitation (TR) in five (4.2%) patients with Kawasaki disease. The diagnosis of valvular disease was confirmed by Doppler echocardiography in all patients. Cardiac murmurs typical of regurgitation were audible in approximately half the patients with MR and AR, and in only one with TR. By chest radiography, cardiomegaly was observed in five of nine patients with MR and in three of six with AR, but in none with TR. Similarly, the ECG finding of cardiac overload was observed in four patients with MR and in three with AR, but in none with TR. Thus, Doppler echocardiography proved very valuable for diagnosing valvular regurgitation in patients with Kawasaki disease. Other cardiovascular complications included coronary artery aneurysms in all except for only one patient with TR. Subsequent myocardial infarction was observed in three patients with MR and in two with AR. Valvular lesions complicating Kawasaki disease generally carry a good prognosis, without progression to stenotic valvular lesions. Although the exact mechanism of this complication is obscure, it is postulated that the valvular lesion results from myocardial infarction or from inflammation of the valvular leaflets or apparatus of the valve following carditis.