Coronary artery aneurysms in Kawasaki disease: the Puerto Rican experience

Kawasaki disease is a newly recognized clinical entity of unknown origin that occurs in the pediatric age and is characterized by multisystemic involvement. Pathologically, widespread vasculitis is present and approximately 10 to 20% of affected children have coronary aneurysms. The latter are mostly silent but 1-2% of them progress to coronary artery obstruction and death from myocardial infarction. Such aneurysms can be visualized by echocardiography and 50% of them apparently resolve, although in some cases, residual coronary artery damage persists after resolution of the aneurysm. The local experience with 116 patients of KD is reported. In only 4 of them significant coronary artery involvement was present. They all remained asymptomatic, the affected arteries were slowly recovering and no fatalities were present. The low incidence of coronary aneurysms and the uneventful course of the disease suggests a milder, less virulent course of KD in our environment. Residual changes in the affected coronary arteries are considered a late risk factor for coronary artery disease in man.