Coronary thrombosis and myocardial ischemia in Kawasaki disease: a case report
Lichao Gao1, Chunhong Xie1, Qing Zhang1
1Department of Cardiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Lane, 310003, Hangzhou, Zhejiang, P. R. China.
Insights
Giant coronary aneurysms in Kawasaki disease can cause thrombosis and ischemia. Early echocardiography and aggressive thrombolytic therapy may be beneficial for high-risk children, improving outcomes.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Vascular Medicine
Background:
- Giant coronary aneurysms in Kawasaki disease are a leading cause of mortality in children.
- Coronary artery thrombosis and myocardial ischemia are significant complications.
- Thrombolytic therapy for coronary thrombosis in Kawasaki disease remains controversial, particularly regarding treatment timing.
Background:
Coronary artery thrombosis and myocardial ischemia caused by giant coronary aneurysms are the main causes of death in children with Kawasaki disease. The use of thrombolytic therapy in children with Kawasaki disease who have coronary thrombosis is a controversial topic, especially with respect to the timing of treatment.
Case Presentation:
In this article, we report a case of a child aged two years and nine months with Kawasaki disease whose coronary arteries had no involvement in the acute phase. However, by only one week after discharge, the patient returned because we found giant coronary aneurysms complicated by thrombosis via echocardiography. Despite aggressive thrombolytic therapy, the child developed myocardial ischemia during thrombolytic therapy. Fortunately, because of timely treatment, the child's thrombus has dissolved, and the myocardial ischemia has resolved.
Conclusions:
This case suggests that for patients at high risk of coronary artery aneurysms, echocardiography may need to be reviewed earlier. Low-molecular-weight heparin should be added to antagonize the early procoagulant effects of warfarin when warfarin therapy is initiated. In the case of first-detected coronary thrombosis, aggressive thrombolytic therapy may be justified, particularly during the acute and subacute phases of the disease course.
