The Spectrum of Cardiovascular Lesions Requiring Intervention in Adults After Kawasaki Disease.

Abstract

OBJECTIVES:

The aim of this study was to characterize the range of management issues raised by adults with cardiovascular sequelae from Kawasaki disease (KD) in childhood.

BACKGROUND:

Aneurysms resulting from vascular inflammation associated with KD in childhood may remain clinically silent until adulthood. Adults with large aneurysms, unstable angina, or myocardial infarction following KD in childhood present unique challenges to interventional cardiologists and cardiothoracic surgeons.

METHODS:

In an observational study of adults with histories of KD in childhood, data were collected regarding the medical histories and outcomes of 154 adult KD patients, of whom 21 underwent either percutaneous interventions or surgery.

RESULTS:

Of the 21 subjects with interventions, 11 had been diagnosed with KD in childhood, and 10 had histories of KD-compatible illnesses. Seventeen subjects were asymptomatic until experiencing acute cardiovascular symptoms: acute myocardial infarction (n = 12), angina (n = 2), end-stage congestive heart failure requiring cardiac transplantation (n = 1), and claudication (n = 2).

CONCLUSIONS:

Cardiovascular complications in these subjects illustrate the following points: 1) even small to moderate-sized aneurysms that "normalize" on echocardiography in childhood can lead to stenosis and thrombosis decades after the acute illness; 2) coronary interventions without intravascular ultrasound may result in clinically significant underestimation of vessel luminal diameter; 3) failure to assess the extent of calcification may lead to suboptimal procedural outcomes; and 4) patients with symptomatic peripheral aneurysms may benefit from endarterectomy or resection. Interventional cardiologists should be aware of the potential challenges in treating this growing population of adults.

• Authors: John B Gordon, Lori B Daniels, Andrew M Kahn, Susan Jimenez-Fernandez, Matthew Vejar, Fujito Numano, Jane C Burns
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 9 Issue 7 Pg. 687-96 (Apr 11 2016) ISSN: 1876-7605 [Electronic] United States
• PMID: 27056307 (Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Age Factors
• Angina Pectoris (etiology, therapy)
• Biopsy
• Cardiac Catheterization (adverse effects)
• Coronary Aneurysm (diagnostic imaging, etiology, therapy)
• Coronary Angiography
• Coronary Artery Bypass (adverse effects)
• Endovascular Procedures (adverse effects)
• Female
• Heart Failure (etiology, therapy)
• Heart Transplantation
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Mucocutaneous Lymph Node Syndrome (complications, diagnosis)
• Myocardial Infarction (etiology, therapy)
• Percutaneous Coronary Intervention (adverse effects)
• Peripheral Vascular Diseases (diagnostic imaging, etiology, therapy)
• Time Factors
• Treatment Outcome
• Ultrasonography, Interventional
• Young Adult