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Li C, Du Y, Wang H, Wu G, Zhu X. Neonatal Kawasaki disease: Case report and literature review. Medicine (Baltimore) 2021; 100:e24624. [PMID: 33607798 PMCID: PMC7899894 DOI: 10.1097/md.0000000000024624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/14/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Kawasaki Disease (KD) is a self-limiting and acute systemic vasculitis of childhood that leads to coronary artery abnormality in about 25% of untreated cases. KD is extremely rare in neonates. The purpose of this paper is to explore the clinical features and diagnosis and treatment of Neonatal Kawasaki Disease for early identification. PATIENT CONCERNS A 24-day-old male with 3 hours fever and a rash was admitted to our hospital. DIAGNOSES He had a fever, rash, cracking of lips, lymph node enlargement in the neck, and distal extremity desquamation. INTERVENTIONS The patient was given intravenous immunoglobulin and aspirin with no complications. OUTCOMES After discharge, the patient was followed up to 1 year old, with good prognosis and no carditis or coronary artery abnormalities. LESSONS Neonatal Kawasaki disease is extremely rare, and its clinical manifestation is not typical and easy to be missed. If not treated early, it will potentially give rise to coronary artery aneurysms or expansion, ischemic heart disease, and sudden death. Early diagnosis and treatment are very important.
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Liu L, Luo C, Hua Y, Wu M, Shao S, Liu X, Zhou K, Wang C. Risk factors associated with progression and persistence of small- and medium-sized coronary artery aneurysms in Kawasaki disease: a prospective cohort study. Eur J Pediatr 2020; 179:891-900. [PMID: 31980953 DOI: 10.1007/s00431-019-03492-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/10/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023]
Abstract
To identify the risk factors of progression and persistence of small- and medium-sized coronary artery aneurysm (CAA) in a contemporary cohort of patients with Kawasaki disease (KD) and to determine the relationship between CAA progression and persistence. A total of 89 KD patients with small- and medium-sized CAA were prospectively enrolled. All patients were followed up at least for 2 years by serial echocardiography. Multivariate logistic regression analysis was conducted to evaluate independent risk factors for CAA progression and persistence. A total of 46 (51.7%) and 73 (82.0%) patients showed echocardiographic CAA regression by 1 month and 24 months of follow-up, respectively. CAA progression was documented in 12 (13.5%) patients during follow-up. The initial aneurysm size according to CAA classification (OR 0.089, 95% CI 0.013-0.634, P = 0.016) and CAA progression (OR 42.618, 95% CI 3.740-485.6, P = 0.003) were independently associated with CAA persistence. The number of involved coronary arteries (OR 0.223, 95% CI 0.065-0.767, P = 0.015) and lymphocyte proportion (OR 1.327, 95% CI 1.019-1.727, P = 0.040) were independently associated with CAA progression.Conclusion: Patients with KD and greater initial aneurysm size, CAA progression, more involved coronary arteries, and lower lymphocyte proportion may require intensive cardiac monitoring and adjuvant therapies.What is Known:• Long-term outcomes of patients with KD and CAA are primarily driven by the consequences of CAA regression and progression.• Regression and progression occurs more frequently in patients with small- and medium-sized CAAs, and less frequently for giant CAAs.What is New:• The CAA size at diagnosis, NCAI, and the proportion of lymphocytes are presumably associated with the small- and medium-sized CAA persistence or CAA progression.• The CAA progression was associated with CAA persistence.
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Affiliation(s)
- Lei Liu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, People South Road, Chengdu, 610041, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Chunyan Luo
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, People South Road, Chengdu, 610041, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mei Wu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, People South Road, Chengdu, 610041, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Shuran Shao
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, People South Road, Chengdu, 610041, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoliang Liu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, People South Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, People South Road, Chengdu, 610041, Sichuan, China.
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, People South Road, Chengdu, 610041, Sichuan, China.
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, China.
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Abstract
BACKGROUND One of the most important complications of Kawasaki disease is the development of giant coronary aneurysms. Risk factors for their development are still not clear. METHODS A retrospective analysis was conducted at the National Institute of Paediatrics in Mexico City, Mexico. It included all patients with a diagnosis of acute Kawasaki disease between August, 1995 and August, 2015. Clinical and laboratory findings, as well as echocardiographic measurements, were recorded. Patients with giant coronary aneurysms (z-score⩾10) were compared with the rest of the patients. A value of p<0.05 was considered statistically significant. Odds ratios and their 95% confidence intervals were calculated to define risk factors. RESULTS During the study period, 416 patients were diagnosed with Kawasaki disease. Of them, 34 developed giant coronary aneurysms during the acute stage of the disease. In the multivariate analysis, patients younger than 1 year, those with a higher duration of illness at the time of diagnosis, and those who received additional intravenous immunoglobulin showed a significantly higher frequency of giant coronary aneurysms. CONCLUSIONS One of the main factors associated with the development of giant coronary aneurysms was the delay in the diagnosis of Kawasaki disease. This finding highlights the importance of maintaining a high suspicion of the disease, which would enable an early diagnosis and prompt treatment and decrease the risk for developing giant coronary aneurysms.
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Paediatric-onset coronary artery anomalies in pregnancy: a single-centre experience and systematic literature review. Cardiol Young 2017; 27:1529-1537. [PMID: 28412993 DOI: 10.1017/s1047951117000658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Individuals with childhood-onset coronary artery anomalies are at increased risk of lifelong complications. Although pregnancy is thought to confer additional risk, a few data are available regarding outcomes in this group of women. We sought to define outcomes of pregnancy in this unique population. METHODS We performed a retrospective survey of women with paediatric-onset coronary anomalies and pregnancy in our institution, combined with a systematic review of published cases. We defined paediatric-onset coronary artery anomalies as congenital coronary anomalies and inflammatory arteriopathies of childhood that cause coronary aneurysms. Major cardiovascular events were defined as pulmonary oedema, sustained arrhythmia requiring treatment, stroke, myocardial infarction, cardiac arrest, or death. RESULTS A total of 25 surveys were mailed, and 20 were returned (80% response rate). We included 46 articles from the literature, which described cardiovascular outcomes in 82 women (138 pregnancies). These data were amalgamated for a total of 102 women and 194 pregnancies; 59% of women were known to have paediatric-onset coronary artery anomalies before pregnancy. In 23%, the anomaly was unmasked during or shortly after pregnancy. The remainder, 18%, was diagnosed later in life. Major cardiovascular events occurred in 14 women (14%) and included heart failure (n=5, 5%), myocardial infarction (n=7, 7%), maternal death (n=2, 2%), cardiac arrest secondary to ventricular fibrillation (n=1, 1%), and stroke (n=1, 1%). The majority of maternal events (13/14, 93%) occurred in women with no previous diagnosis of coronary disease. CONCLUSIONS Women with paediatric-onset coronary artery anomalies have a 14% risk of adverse cardiovascular events in pregnancy, indicating the need for careful assessment and close follow-up. Prospective, multicentre studies are required to better define risk and predictors of complications during pregnancy.
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Denby KJ, Clark DE, Markham LW. Management of Kawasaki disease in adults. Heart 2017; 103:1760-1769. [DOI: 10.1136/heartjnl-2017-311774] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 12/26/2022] Open
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Novel Percutaneous Coronary Intervention Techniques for Revascularizing Chronically Occluded Giant Coronary Aneurysms in a Patient with Kawasaki Disease. Pediatr Cardiol 2016; 37:1392-5. [PMID: 27393479 DOI: 10.1007/s00246-016-1446-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
Kawasaki disease is a self-limiting vasculitis presenting in childhood that can lead to aneurysms of the coronary arteries. Patients who develop giant coronary aneurysms have a high incidence of coronary stenoses and occlusions resulting in myocardial ischemia. The mainstay of treatment for these lesions is surgical bypass due to complex coronary anatomy and a high rate of chronic total occlusions precluding traditional percutaneous coronary intervention techniques. We report the first successful percutaneous revascularization of two chronically occluded giant coronary aneurysms using the Hybrid Interventional Strategy for approaching chronic total occlusions. Both antegrade and retrograde dissection-reentry techniques were employed to fully revascularize two major epicardial arteries. Despite procedural success, longer-term vessel patency was not maintained following stent deployment highlighting the difficulty in maintaining durable results with percutaneous coronary intervention in this patient population.
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Sun Y, Yuan Y, Yan H, Wan H, Li X, Chen S, Li H, Tang C, Du J, Liu G, Jin H. Plasma H2S predicts coronary artery lesions in children with Kawasaki disease. Pediatr Int 2015; 57:840-4. [PMID: 25808254 DOI: 10.1111/ped.12631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 01/17/2015] [Accepted: 02/13/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this study was to determine whether plasma hydrogen sulfide (H2S) is a biomarker for predicting coronary artery lesions (CAL) in children with Kawasaki disease (KD). METHODS A prospective study was conducted on 50 KD patients and 27 healthy children. Plasma H2 S was analyzed at the acute stage. Plasma H2S was detected using the sensitive electrode method, and receiver operating characteristic curve (ROC) analysis was carried out. RESULTS Plasma H2S in KD patients at the acute stage was significantly lower than that of controls. CAL patients had reduced plasma H2S at acute stage compared with the non-CAL patients. A plasma H2S cut-off of 31.2 µmol/L provided a sensitivity of 81% and a specificity of 62.5% for predicting coronary injuries in KD. Optimal specificity and sensitivity were obtained when using plasma H2S to predict CAL in KD children. CONCLUSION Plasma H2S level in the acute period is a potentially useful biomarker for predicting CAL in KD children.
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Affiliation(s)
- Yan Sun
- Department of Pediatrics, Peking University First Hospital
| | - Yue Yuan
- Department of Pediatric Cardiology, Beijing Children's Hospital
| | - Hui Yan
- Department of Pediatrics, Peking University First Hospital
| | - Hong Wan
- Department of Pediatrics, Peking University First Hospital
| | - Xueying Li
- Department of Medical Statistics, Peking University First Hospital
| | - Siyao Chen
- Department of Pediatrics, Peking University First Hospital
| | - Hongxia Li
- Department of Pediatrics, Peking University First Hospital
| | - Chaoshu Tang
- Department of Physiology and Pathophysiology, Peking University Health Science Center
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital.,Key Laboratory of Molecular Cardiology, Ministry of Education
| | - Guiying Liu
- Department of Pediatrics, Beijing Anzhen Hospital, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital
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Shah V, Christov G, Mukasa T, Brogan KS, Wade A, Eleftheriou D, Levin M, Tulloh RM, Almeida B, Dillon MJ, Marek J, Klein N, Brogan PA. Cardiovascular status after Kawasaki disease in the UK. Heart 2015; 101:1646-55. [PMID: 26316045 PMCID: PMC4621377 DOI: 10.1136/heartjnl-2015-307734] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/07/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Kawasaki disease (KD) is an acute vasculitis that causes coronary artery aneurysms (CAA) in young children. Previous studies have emphasised poor long-term outcomes for those with severe CAA. Little is known about the fate of those without CAA or patients with regressed CAA. We aimed to study long-term cardiovascular status after KD by examining the relationship between coronary artery (CA) status, endothelial injury, systemic inflammatory markers, cardiovascular risk factors (CRF), pulse-wave velocity (PWV) and carotid intima media thickness (cIMT) after KD. METHODS Circulating endothelial cells (CECs), endothelial microparticles (EMPs), soluble cell-adhesion molecules cytokines, CRF, PWV and cIMT were compared between patients with KD and healthy controls (HC). CA status of the patients with KD was classified as CAA present (CAA+) or absent (CAA-) according to their worst-ever CA status. Data are median (range). RESULTS Ninety-two KD subjects were studied, aged 11.9 years (4.3-32.2), 8.3 years (1.0-30.7) from KD diagnosis. 54 (59%) were CAA-, and 38 (41%) were CAA+. There were 51 demographically similar HC. Patients with KD had higher CECs than HC (p=0.00003), most evident in the CAA+ group (p=0.00009), but also higher in the CAA- group than HC (p=0.0010). Patients with persistent CAA had the highest CECs, but even those with regressed CAA had higher CECs than HC (p=0.011). CD105 EMPs were also higher in the KD group versus HC (p=0.04), particularly in the CAA+ group (p=0.02), with similar findings for soluble vascular cell adhesion molecule 1 and soluble intercellular adhesion molecule 1. There was no difference in PWV, cIMT, CRF or in markers of systemic inflammation in the patients with KD (CAA+ or CAA-) compared with HC. CONCLUSIONS Markers of endothelial injury persist for years after KD, including in a subset of patients without CAA.
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Affiliation(s)
- V Shah
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - G Christov
- Department of Paediatric Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - T Mukasa
- Department of Paediatric Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - K S Brogan
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - A Wade
- Department of Clinical Epidemiology, Nutrition and Biostatistics Section, UCL Institute of Child Health, London, UK
| | - D Eleftheriou
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - M Levin
- Paediatric Infectious diseases group, Division of Medicine, Imperial College London, London, UK
| | - R M Tulloh
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - B Almeida
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - M J Dillon
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - J Marek
- Department of Paediatric Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - N Klein
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
| | - P A Brogan
- Infection, Inflammation and Rheumatology Section, UCL Institute of Child Health, London, UK
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Greco A, De Virgilio A, Rizzo MI, Tombolini M, Gallo A, Fusconi M, Ruoppolo G, Pagliuca G, Martellucci S, de Vincentiis M. Kawasaki disease: An evolving paradigm. Autoimmun Rev 2015; 14:703-9. [DOI: 10.1016/j.autrev.2015.04.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/02/2015] [Indexed: 12/22/2022]
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Ye Q, Shao WX, Shang SQ, Zhang T, Hu J, Zhang CC. A Comprehensive Assessment of the Value of Laboratory Indices in Diagnosing Kawasaki Disease. Arthritis Rheumatol 2015; 67:1943-50. [PMID: 25778686 DOI: 10.1002/art.39112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 03/05/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Qing Ye
- The Children's Hospital of Zhejiang University School of Medicine and Zhejiang Key Laboratory for the Diagnosis and Treatment of Neonatal Diseases; Hangzhou China
| | - Wen-xia Shao
- Hangzhou First People's Hospital; Hangzhou China
| | - Shi-qiang Shang
- The Children's Hospital of Zhejiang University School of Medicine; Hangzhou China
| | - Ting Zhang
- Zhejiang Chinese Medical University; Hangzhou China
| | - Jian Hu
- The Children's Hospital of Zhejiang University School of Medicine; Hangzhou China
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Ye Q, Shao WX, Shang SQ, Zhou MM. Value of the N-terminal of prohormone brain natriuretic peptide in diagnosis of Kawasaki disease. Int J Cardiol 2015; 178:5-7. [DOI: 10.1016/j.ijcard.2014.10.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
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Su D, Wang K, Qin S, Pang Y. Safety and Efficacy of Warfarin plus Aspirin Combination Therapy for Giant Coronary Artery Aneurysm Secondary to Kawasaki Disease: A Meta-Analysis. Cardiology 2014; 129:55-64. [DOI: 10.1159/000363732] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/19/2014] [Indexed: 11/19/2022]
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Gordon CT, Jimenez-Fernandez S, Daniels LB, Kahn AM, Tarsa M, Matsubara T, Shimizu C, Burns JC, Gordon JB. Pregnancy in women with a history of Kawasaki disease: management and outcomes. BJOG 2014; 121:1431-8. [PMID: 24597833 DOI: 10.1111/1471-0528.12685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To characterise the obstetrical management and outcomes in a series of women with a history of Kawasaki disease (KD) in childhood. DESIGN Retrospective case series. SETTING Tertiary healthcare setting in the USA. POPULATION Women with a history of KD in childhood. METHODS Women completed a detailed health questionnaire and participated in research imaging studies as part of the San Diego Adult KD Collaborative Study. MAIN OUTCOME MEASURES Obstetrical management, complications during pregnancy and delivery, and infant outcomes. RESULTS Ten women with a history of KD in childhood carried a total of 21 pregnancies to term. There were no cardiovascular complications during labour and delivery despite important cardiovascular abnormalities in four of the ten subjects. Pregnancy was complicated by pre-eclampsia and the post-partum course was complicated by haemorrhage in one subject each. Two of the 21 progeny subsequently developed KD. CONCLUSIONS Women with important cardiovascular sequelae from KD in childhood should be managed by a team that includes both a maternal-fetal medicine specialist and a cardiologist. Pre-pregnancy counselling should include delineation of the woman's current functional and structural cardiovascular status and appropriate adjustment of medications, but excellent outcomes are possible with appropriate care. Review of the English and Japanese literature on KD and pregnancy revealed the occurrence of myocardial infarction during pregnancy in women with missed KD and aneurysms that were not diagnosed until their acute event. Our study highlights the need for counselling with regard to the increased genetic risk of KD in offspring born to these mothers.
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Affiliation(s)
- C T Gordon
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
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Yim D, Curtis N, Cheung M, Burgner D. An update on Kawasaki disease II: clinical features, diagnosis, treatment and outcomes. J Paediatr Child Health 2013; 49:614-23. [PMID: 23647873 DOI: 10.1111/jpc.12221] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2012] [Indexed: 01/30/2023]
Abstract
This is the second of two updates on Kawasaki disease. The first review focused on epidemiology and aetio-pathogenesis. Here, we review the clinical features and diagnosis of Kawasaki disease, as well as recent evidence on treatment, follow-up and cardiovascular outcomes.
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Affiliation(s)
- Deane Yim
- Department of Cardiology, The University of Melbourne, Melbourne, Victoria, Australia
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Sengupta D, Kahn AM, Burns JC, Sankaran S, Shadden SC, Marsden AL. Image-based modeling of hemodynamics in coronary artery aneurysms caused by Kawasaki disease. Biomech Model Mechanobiol 2011; 11:915-32. [PMID: 22120599 DOI: 10.1007/s10237-011-0361-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 11/07/2011] [Indexed: 11/25/2022]
Abstract
Kawasaki Disease (KD) is the leading cause of acquired pediatric heart disease. A subset of KD patients develops aneurysms in the coronary arteries, leading to increased risk of thrombosis and myocardial infarction. Currently, there are limited clinical data to guide the management of these patients, and the hemodynamic effects of these aneurysms are unknown. We applied patient-specific modeling to systematically quantify hemodynamics and wall shear stress in coronary arteries with aneurysms caused by KD. We modeled the hemodynamics in the aneurysms using anatomic data obtained by multi-detector computed tomography (CT) in a 10-year-old male subject who suffered KD at age 3 years. The altered hemodynamics were compared to that of a reconstructed normal coronary anatomy using our subject as the model. Computer simulations using a robust finite element framework were used to quantify time-varying shear stresses and particle trajectories in the coronary arteries. We accounted for the cardiac contractility and the microcirculation using physiologic downstream boundary conditions. The presence of aneurysms in the proximal coronary artery leads to flow recirculation, reduced wall shear stress within the aneurysm, and high wall shear stress gradients at the neck of the aneurysm. The wall shear stress in the KD subject (2.95-3.81 dynes/sq cm) was an order of magnitude lower than the normal control model (17.10-27.15 dynes/sq cm). Particle residence times were significantly higher, taking 5 cardiac cycles to fully clear from the aneurysmal regions in the KD subject compared to only 1.3 cardiac cycles from the corresponding regions of the normal model. In this novel quantitative study of hemodynamics in coronary aneurysms caused by KD, we documented markedly abnormal flow patterns that are associated with increased risk of thrombosis. This methodology has the potential to provide further insights into the effects of aneurysms in KD and to help risk stratify patients for appropriate medical and surgical interventions.
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Affiliation(s)
- Dibyendu Sengupta
- Department of Mechanical and Aerospace Engineering, University of California San Diego-UCSD, San Diego, CA, USA
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