Physiologic significance of chronic coronary aneurysms in patients with Kawasaki disease
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Z M Hijazi1, J E Udelson, H Snapper
1Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts.
Insights
Persistent coronary aneurysms in Kawasaki disease can affect myocardial perfusion and function, especially when associated with stenosis. However, many aneurysms, including giant ones, show normal coronary flow reserve and preserved heart function during stress.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Vascular Biology
Background:
- Kawasaki disease can lead to sudden death from coronary artery stenosis or chronic coronary aneurysms.
- Understanding the long-term cardiovascular implications of coronary aneurysms is crucial.
Purpose of the Study:
- To investigate the association between persistent coronary aneurysms in Kawasaki disease patients and myocardial perfusion and function.
- To assess the impact of coronary aneurysms on regional heart muscle activity and blood flow during exercise.
Main Methods:
- Eleven patients with chronic coronary aneurysms underwent assessment.
- Coronary aneurysm size and stenosis were evaluated using angiography and echocardiography.
- Simultaneous myocardial perfusion (technetium-99m sestamibi imaging) and function (echocardiography) were assessed during exercise.
Main Results:
- 18 of 33 vascular territories had coronary aneurysms; 3 were linked to significant stenosis.
- Five aneurysmal territories showed stress-induced perfusion defects, with 4 having wall motion abnormalities.
- Three stenotic coronary arteries supplied territories with abnormal regional function and perfusion during exercise.
Conclusions:
- Chronic coronary aneurysms, particularly those with stenosis, can impair myocardial perfusion and function.
- The majority of coronary aneurysms, even giant ones, are associated with normal coronary flow reserve and preserved regional myocardial function during stress.
Objectives:
The aim of this study was to determine whether persistent coronary aneurysms in patients with Kawasaki disease are associated with altered myocardial perfusion and function.
Background:
Some patients with Kawasaki disease have died suddenly because of severe coronary artery stenosis; others have chronic coronary aneurysms.
Methods:
Eleven patients with chronic coronary aneurysms were enrolled in the study. The size of the aneurysms and the degree of associated stenosis were determined by angiography in nine patients and by echocardiography in two. All patients underwent simultaneous function and myocardial perfusion assessment during symptom-limited exercise by echocardiography and technetium-99m sestamibi imaging, respectively.
Results:
Of 33 vascular territories, 18 contained coronary aneurysms measuring 3.5 to 10 mm. Three aneurysms were associated with significant stenosis as detected by angiography. Of the 18 vascular territories, 13 were normal, and 5 manifested stress-induced perfusion defects; of the latter 5 areas, 4 had associated wall motion abnormalities. The three territories supplied by stenotic coronary arteries had both abnormal regional function and perfusion demonstrated during exercise.
Conclusions:
Patients with chronic coronary aneurysms may have associated stenosis, as detected by angiography, with a subjacent myocardium that is subject to abnormal perfusion and function. However, the majority of coronary aneurysms are associated with normal regional coronary flow reserve, as assessed by myocardial perfusion imaging, and even giant coronary aneurysms may be associated with normal coronary flow reserve and preserved regional myocardial function during stress.