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[Kawasaki's disease. Epidemiological aspects and cardiovascular manifestations. Apropos of 106 cases]
Insights
Kawasaki disease can cause cardiovascular issues, including coronary aneurysms in some children. Serial two-dimensional echocardiography is crucial for early detection and monitoring of these aneurysms.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Diagnostic Imaging
Context:
- Kawasaki disease (KD) is a significant cause of acquired heart disease in children.
- Cardiovascular involvement is a primary concern in KD management.
- Early detection and monitoring of cardiac complications are vital.
Purpose:
- To evaluate cardiovascular manifestations in pediatric patients with Kawasaki disease.
- To assess the utility of serial electrocardiograms (ECGs) and echocardiograms (M-mode and 2D) in diagnosing and monitoring KD complications.
- To investigate the development, regression, and long-term outcomes of coronary aneurysms in KD patients.
Summary:
- A study of 106 Kawasaki disease patients revealed cardiovascular manifestations in 50%, including transient ECG and M-mode echocardiogram abnormalities.
- Six percent developed coronary aneurysms, detected by 2D echocardiography and confirmed by angiography or autopsy.
- No correlation was found between clinical severity or initial ECG/M-mode echo findings and aneurysm development.
Impact:
- Highlights the importance of serial 2D echocardiography for timely diagnosis and management of coronary aneurysms in Kawasaki disease.
- Emphasizes that M-mode echocardiography and ECG findings may be transient and not predictive of coronary artery issues.
- Provides insights into the natural history and resolution patterns of coronary aneurysms in KD.
Abstract:
One hundred and six patients fulfilling accepted diagnostic criteria for Kawasaki disease (90 p. 100 of French-Canadian origin) were evaluated with serial electrocardiograms and echocardiograms (M mode and two-dimensional). Half of the patients (53) had cardiovascular manifestations at one time during their illness. Thirty-one had abnormal electrocardiograms: non specific ST and T wave changes inferiorly (27), prolonged QT intervals (6), first degree AV block (3). M mode echo was abnormal in 31 cases showing: slight pericardial effusion (17), flat septal movement (11), left ventricular dilatation (4), decrease of shortening fraction (2). Seven patients (6.4 p. 100) presented fusiform coronary aneurysm detected in 6 by two-dimensional echography (with angiographic confirmation) and at autopsy in another. M mode echo and electrocardiogram abnormalities were transient in the great majority of patients disappearing during an average follow-up period of 10 months. Coronary aneurysm had disappeared at the end of follow-up in two patients, regressed in three and remained identical in another. There were no relations between severity of clinical symptoms, electrocardiographic or echocardiographic (M mode) abnormalities and the development of coronary aneurysm. Serial studies with two-dimensional echo should be done in every patient with this disease for early detection and follow-up of coronary aneurysm.