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Mucocutaneous lymph node syndrome: clinical, hemodynamic and angiographic features of coronary obstructive disease
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Kawasaki disease can cause severe coronary artery obstruction in children, leading to heart problems like reduced left ventricular function and mitral regurgitation. More severe obstructions correlate with worse outcomes and higher mortality rates.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Rheumatology
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Coronary artery abnormalities are a significant complication, potentially leading to long-term sequelae.
Purpose of the Study:
- To evaluate clinical, hemodynamic, and angiographic features of coronary obstructive disease in children with Kawasaki disease.
- To assess the impact of coronary obstruction severity on cardiac function and patient outcomes.
Main Methods:
- Retrospective analysis of 30 patients with Kawasaki disease and significant coronary artery obstruction (≥90% diameter reduction).
- Evaluation of clinical symptoms, cardiac catheterization data, and left ventricular function parameters.
- Correlation of obstruction location and severity with cardiac symptoms, hemodynamic abnormalities, and mortality.
Main Results:
- Obstructive lesions were found in various coronary arteries, with higher rates of cardiac symptoms and abnormal left ventricular function in more severe obstruction groups.
- Myocardial infarction occurred in 33% of patients.
- Mortality was significantly higher in patients with obstructions in multiple coronary arteries or the left main coronary artery (groups 3 and 4).
Conclusions:
- Coronary obstruction in Kawasaki disease can lead to depressed left ventricular function, mitral regurgitation, and wall motion abnormalities.
- The severity and location of coronary obstruction are critical determinants of cardiac dysfunction and prognosis in affected children.
Abstract:
Clinical, hemodynamic and angiographic features of coronary obstructive disease (greater than or equal to 90% diameter reduction) in Kawasaki disease were evaluated in 30 patients. The mean age at the onset of Kawasaki disease was 2.9 +/- 1.9 years and that at cardiac catheterization was 6.3 +/- 2.8 years. Obstructive lesions were observed in the right coronary artery in 12 patients (group 1), in the left anterior descending coronary artery (LAD) in 6 (group 2), in both right coronary artery and LAD in 10 (group 3) and in the left main coronary artery in 4 (group 4). Twenty-two patients (73%) had cardiac symptoms, including myocardial infarction in 10 (33%). Cardiac symptoms were observed in 41% in group 1, 100% in group 2, 80% in group 3 and 100% in group 4. Left ventricular (LV) end-diastolic pressure, end-diastolic volume and ejection fraction were abnormal in 32% of the patients in group 1, a frequency less than that in other groups (83% in group 2, 78% in group 3 and 100% in group 4). Fifty percent had mitral regurgitation and 73% had left ventricular wall motion abnormalities. No patient in groups 1 or 2 has died, but 8 of 14 patients in groups 3 and 4 have died. These observations indicate that coronary obstruction owing to Kawasaki disease can cause depressed LV function, mitral regurgitation and LV wall motion abnormalities in children.(ABSTRACT TRUNCATED AT 250 WORDS)