Ryuji Fukazawa1, Tohru Kobayashi2, Masashi Mikami3, Tsutomu Saji4, Kenji Hamaoka5, Hitoshi Kato6, Hiroyuki Suzuki7, Etsuko Tsuda8, Mamoru Ayusawa9, Masaru Miura10, Ryota Ebata11, Tomio Kobayashi12, Mayumi Yashiro13, Shunichi Ogawa1. 1. Department of Pediatrics, Nippon Medical School. 2. Division of Clinical Research Planning, Department of Development Strategy, Center for Clinical Research and Development, National Center for Child Health and Development. 3. Division of Biostatistics, Department of Data Management, Center for Clinical Research and Development, National Center for Child Health and Development. 4. First Department of Pediatrics, Toho University Omori Medical Center. 5. Kyoto Prefectural University of Medicine, Graduate School of Medical Science. 6. Department of Cardiology, National Center for Child Health and Development. 7. Department of Pediatrics, Wakayama Medical University. 8. Department of Pediatrics Cardiovascular Surgery, National Cerebral and Cardiovascular Center. 9. Department of Pediatrics, Nihon University School of Medicine. 10. Division of Cardiology, Tokyo Metropolitan Children's Medical Center. 11. Department of Pediatrics, Graduate School of Medicine, Chiba University. 12. Division of Cardiology, Gunma Children's Medical Center. 13. Department of Public Health, Jichi Medical University.
Abstract
BACKGROUND: Giant coronary aneurysm is the most severe sequela in Kawasaki disease, occurring in approximately 0.2% of patients in Japan. Regression is rare, while myocardial infarction (MI) and sudden death are relatively common. Herein, we reviewed patients with giant coronary aneurysm in a 10-year period.Methods and Results: A nationwide questionnaire survey was conducted based on a national epidemiological database from 1999 to 2010. We identified 355 giant coronary aneurysm patients, of whom 209 were analyzed. The 5- and 10-year total cardiac event-free rates were 0.72 and 0.68, respectively. Twelve patients died, and MI was observed in 32 patients (18.1%). Five and 6 deaths were due to coronary rupture and MI, respectively. All ruptures occurred within 1 month of onset, while most MI occurred within 18 months. There was no death beyond 2 years. Aneurysm size was significantly related to the occurrence of MI in both the right and left coronary arteries. At the time of writing, 55% of patients had no exercise limitations. And including patients who cannot perform strenuous exercises, 81% of patients were leading ordinary lives. CONCLUSIONS: Severe cardiac events are likely to occur within 2 years from onset of Kawasaki disease, while no deaths occurred beyond this time. Hence, careful monitoring is needed especially for the first 2 years. Most patients with giant coronary aneurysms can lead ordinary lives with appropriate management.
BACKGROUND:Giant coronary aneurysm is the most severe sequela in Kawasaki disease, occurring in approximately 0.2% of patients in Japan. Regression is rare, while myocardial infarction (MI) and sudden death are relatively common. Herein, we reviewed patients with giant coronary aneurysm in a 10-year period.Methods and Results: A nationwide questionnaire survey was conducted based on a national epidemiological database from 1999 to 2010. We identified 355 giant coronary aneurysmpatients, of whom 209 were analyzed. The 5- and 10-year total cardiac event-free rates were 0.72 and 0.68, respectively. Twelve patients died, and MI was observed in 32 patients (18.1%). Five and 6 deaths were due to coronary rupture and MI, respectively. All ruptures occurred within 1 month of onset, while most MI occurred within 18 months. There was no death beyond 2 years. Aneurysm size was significantly related to the occurrence of MI in both the right and left coronary arteries. At the time of writing, 55% of patients had no exercise limitations. And including patients who cannot perform strenuous exercises, 81% of patients were leading ordinary lives. CONCLUSIONS: Severe cardiac events are likely to occur within 2 years from onset of Kawasaki disease, while no deaths occurred beyond this time. Hence, careful monitoring is needed especially for the first 2 years. Most patients with giant coronary aneurysms can lead ordinary lives with appropriate management.
Entities:
Keywords:
Aneurysm; Coronary disease; Kawasaki disease; Remote period
Authors: Michael A Portman; Nagib S Dahdah; April Slee; Aaron K Olson; Nadine F Choueiter; Brian D Soriano; Sujatha Buddhe; Carolyn A Altman Journal: Pediatrics Date: 2019-05-02 Impact factor: 7.124