Percutaneous transluminal coronary angioplasty in a child with Kawasaki disease
1Department of Pediatrics, Seoul National University College of Medicine, Korea.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) successfully treated mid-left anterior descending artery stenosis in a child with Kawasaki disease. This intervention prevented further myocardial damage, highlighting early PTCA for subclinical stenosis.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Kawasaki Disease Research
Background:
- Kawasaki disease frequently causes coronary artery aneurysms and stenosis in children.
- Long-term sequelae include myocardial ischemia and infarction due to progressive coronary stenosis.
- Management of significant stenosis in pediatric patients remains a challenge.
Observation:
- A 6-year-old boy with Kawasaki disease presented with multiple coronary aneurysms and stenosis.
- Despite 4 years of follow-up, he developed significant stenosis (70%) in the mid-left anterior descending artery.
- Myocardial perfusion defects were noted on 99mTc-MIBI SPECT with dipyridamole infusion.
Findings:
- Successful percutaneous transluminal coronary angioplasty (PTCA) reduced stenosis from 70% to 20%.
- Angiography at 26 months showed no restenosis at the intervention site.
- The patient remained asymptomatic with improved myocardial perfusion post-procedure.
Implications:
- Early PTCA can be a safe and effective treatment for subclinical coronary stenosis in pediatric patients with Kawasaki disease.
- This approach may prevent ischemic cardiac damage and improve long-term outcomes.
- Consideration of early intervention strategies is crucial for managing coronary sequelae of Kawasaki disease.
Abstract:
A successful attempt at percutaneous transluminanl coronary angioplasty (PTCA) to relieve stenosis of the mid-portion of the left anterior descending artery was achieved in a 6-year 9-month old boy who had multiple coronary aneurysms and stenosis due to Kawasaki disease. Despite the progression of coronary stenosis he had been well except for the perfusion defect of the anterior wall of myocardium on 99mTc-MIBI SPECT with dipyridamole infusion until PTCA was carried out after 4-year 4-months of the onset of illness. The area of stenosis was 70% before PTCA and 20% after PTCA. No restenosis at the site of PTCA was observed on follow-up angiography at 26 months after PTCA. This successful attempt may indicate that this procedure should be considered early in subclinical stenosis to prevent ischemic cardiac damage.
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