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Cardiac biopsy of Kawasaki disease
Insights
Kawasaki disease can cause coronary artery aneurysms in children. Myocardial changes, including myocarditis and fibrosis, are present in all cases and may lead to cardiomyopathy.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Pathology
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Understanding the cardiac manifestations is crucial for long-term patient outcomes.
Purpose of the Study:
- To investigate the vascular and myocardial changes in children with Kawasaki disease.
- To correlate histopathological findings with clinical presentation and potential long-term sequelae.
Main Methods:
- Coronary angiography, ultrasonic tomography, myocardial imaging, and right ventricular myocardial biopsy were performed on 201 pediatric patients.
- Histopathological analysis focused on coronary arteries and intramural vessels.
Main Results:
- Coronary artery aneurysms occurred in 12.9% of patients.
- All patients exhibited round-cell myocarditis and fibrosis, which persisted over time.
- Myocyte disarray and hypertrophy correlated with myocarditis, not coronary arteritis.
Conclusions:
- Kawasaki disease causes persistent myocardial changes, including myocarditis and fibrosis.
- These myocardial alterations may predispose some children to developing cardiomyopathy.
- The study provides scoring criteria for evaluating biopsy specimens.
Abstract:
Two hundred one patients (138 boys, 63 girls), 1 month to 11 years old, with Kawasaki disease underwent coronary angiography, ultrasonic tomography, myocardial imaging, and biopsy of right ventricular myocardium. Aneurysms of epicardial coronary arteries, mostly left, occurred in 26 cases (12.9%). Degeneration and proliferation of endothelium, edema, scarring, and fibrosis, slight to moderate, involved the tunicae of intramural small vessels in all cases. These changes tended to abate with time. The basic lesion of Kawasaki disease, round-cell myocarditis and fibrosis, involved all cases and persisted. Disarrangement, abnormal branching, disarray, and hypertrophy of myocytes correlated significantly with myocarditis, but not with epimural or intramural coronary angitis. As a consequence of the myocardial changes, it is suggested that some cases may terminate as myocardiopathy. Scoring criteria for vascular and myocardial changes in biopsy specimens are included.