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[Cardiovascular complications of Kawasaki disease: clinical cases]
F Sica1, E d'Amato, T Colapietra
1Divisione di Pediatria, Ospedali Riuniti di Foggia, Italia.
Insights
Early treatment of Kawasaki disease (K.D.) with intravenous immunoglobulin significantly reduces coronary artery aneurysms. Prompt diagnosis is crucial for preventing long-term cardiac complications in affected children.
Area of Science:
- Pediatrics
- Cardiology
- Immunology
Background:
- Kawasaki disease (K.D.) is a pediatric illness with potential cardiac sequelae.
- Etiology and pathogenesis of K.D. are not fully understood.
- Coronary artery abnormalities affect 15-25% of untreated K.D. cases.
Purpose of the Study:
- To report cases of Kawasaki disease observed between 1988-1991.
- To evaluate the treatment efficacy of intravenous immunoglobulin (IVIG) and other medications.
- To monitor for coronary artery abnormalities and their regression.
Main Methods:
- Diagnosis followed CDC Atlanta guidelines.
- Treatment included IVIG (500 mg/kg/day for 5 days), Aspirin, and Dipyridamole.
- ECG and echocardiograms were performed at regular intervals post-onset.
Main Results:
- One of 8 children developed coronary aneurysms.
- Aneurysms showed echocardiographic regression within 6 months.
- Early IVIG treatment reduced the incidence of coronary artery aneurysms.
Conclusions:
- Early diagnosis and treatment of Kawasaki disease are vital.
- Intravenous immunoglobulin therapy in early stages reduces coronary artery aneurysm incidence.
- Long-term prognosis and treatment strategies for K.D. are becoming better defined.
Abstract:
The Authors report the cases of Kawasaki disease (K.D.) observed between July 1988 and october 1991 in OO.RR.'s Pediatric Division of Foggia. The diagnosis was made according to the C.D.C.'s Atlanta diagnostic guidelines. All children were treated (whithin the first 10 days of onset of illness) with intravenous immune-globuline (500 mg/kg/die for 5 days) and with Asa and Dypiridamol for two months after they were without temperature. The patients with coronaric sequelae repeated after 4 weeks a second cycle of intravenous immuno-globuline therapy and continued Asa and Dypiridamol therapy until two months after disappearance of coronary arterial abnormalities. All patients performed ECG at 3-15-30 days and at 180-360 days from the onset of illness. A mono-bidimensional ecocardiogram was performed twice a week in the first month, bi-monthly in the next months and after 180-360 days from the onset of illness. One of the 8 children developed coronary aneurysms, which regressed echocardiographycally during the first 6 months after the acute illness. While the etiology and pathogenesis of K.D. remain incompletely understood, the clinical spectrum of the disorder and its long-term prognosis and treatment are becoming increasingly well defined. Coronary artery aneurysms developed in 15-25% of cases, with a mortality for coronary artery thrombosis of 1-2% of cases. Intravenous immuno-globuline infusion given in the early phases of the disorder reduce the incidence of coronary artery aneurysms therefore an early diagnosis is important to prevent coronary artery abnormalities.