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Visi G, Spina F, Del Duca F, Manetti AC, Maiese A, La Russa R, Frati P, Fineschi V. Autoptic Findings in Cases of Sudden Death Due to Kawasaki Disease. Diagnostics (Basel) 2023; 13:diagnostics13111831. [PMID: 37296682 DOI: 10.3390/diagnostics13111831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Kawasaki disease (KD) is the second-most-common childhood vasculitis, and its etiology is still unknown today. Even though the acute illness is usually self-limiting, sometimes, it can generate complications, such as coronary artery aneurysms (CAA), acute myocardial infarction (AMI), heart failure, or arrhythmias, and can rarely cause sudden or unexpected deaths. We present a review of the literature, which collects autoptic and histopathological data relating to many of the cases of these deaths. On the basis of the titles and abstracts, we selected 54 scientific publications for a total of 117 cases. Among them, as expected, the majority of the deaths were due to AMI (41.03%), arrhythmia (8.55%), acute coronary syndrome (8.55%), and CAA rupture (11.97%), involving mostly 20-year-olds or younger individuls (69.23%). This is not surprising since the CAs are the most involved arteries. Gross autoptic and histopathological findings are reported in the paper. Our work revealed that, when compared with the incidence of KD, only a few cases suffered from sudden death, underwent an autoptic examination, and were then described in the literature. We suggest that researchers should perform autopsies to gain a better understanding of the molecular pathways involved in KD so as to propose further innovative therapeutic protocols or implement more appropriate prevention schemes.
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Affiliation(s)
- Giacomo Visi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Federica Spina
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Alice Chiara Manetti
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, 71122 Foggia, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
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Lee J, Seo J, Shin YH, Jang AY, Suh SY. ST-segment elevation myocardial infarction in Kawasaki disease: A case report and review of literature. World J Clin Cases 2022; 10:9368-9377. [PMID: 36159436 PMCID: PMC9477670 DOI: 10.12998/wjcc.v10.i26.9368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm (CAA). CAAs are associated with a high rate of adverse cardiovascular events.
CASE SUMMARY A Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain. Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram. An aneurysm of the left circumflex (LCX) coronary artery was found with massive thrombi within. A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications. The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7, suggestive of a small aneurysm considering his age, sex, and body surface area. We further present a case series of 19 patients with KD, including the current patient, presenting with acute coronary syndrome (ACS). Notably, none of the cases showed Z scores; only five patients (26%) had been regularly followed up by a physician, and only one patient (5.3%) was being treated with antithrombotic therapy before ACS occurred.
CONCLUSION For KD presenting with ACS, regular follow up and medical therapy may be crucial for improved outcomes.
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Affiliation(s)
- Joonpyo Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 21565, South Korea
| | - Jeongduk Seo
- Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 21565, South Korea
| | - Yong Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 21565, South Korea
| | - Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 21565, South Korea
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 21565, South Korea
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Mirza SJ, Mohammed KO, Baslaib FO. Myocardial infarction in a young man due to coronary artery aneurysms after an undiagnosed Kawasaki disease. J Emerg Med 2014; 46:763-766. [PMID: 24565879 DOI: 10.1016/j.jemermed.2013.11.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 10/26/2013] [Accepted: 11/17/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Kawasaki disease usually affects infants and young children. It often goes unrecognized in adults due to varying symptoms and lack of definite diagnostic criteria. OBJECTIVES To describe the potential for acute myocardial infarction as a complication of antecedent Kawasaki Disease (KD). CASE REPORT We describe a case of a 19-year-old man who presented to the Emergency Department (ED) with an acute myocardial infarction that was subsequently determined to be the result of previously untreated KD. CONCLUSION Kawasaki disease can cause coronary complications in a teenager. A high level of suspicion in the ED can help in proper management of these patients.
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Affiliation(s)
- Sumbul Javed Mirza
- Department of Cardiology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Khalifa Omar Mohammed
- Department of Cardiology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Fahad Omar Baslaib
- Department of Cardiology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Hung JJ, Chiu CH. Pulse methylprednisolone therapy in the treatment of immune globulin-resistant Kawasaki disease: case report and review of the literature. ACTA ACUST UNITED AC 2013; 24:89-93. [PMID: 15005973 DOI: 10.1179/027249304225013330] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A subgroup of patients with Kawasaki disease (KD) did not respond to intravenous immune globulin (IVIG) therapy. Corticosteroid therapy remains a controversial alternative in such cases. We report two young children with KD who failed to respond to three courses of IVIG therapy and subsequently received pulse methylprednisolone as an alternative. One had a satisfactory outcome but the other developed giant coronary aneurysms and had a myocardial infarction 2 months after onset of the illness. A review of relevant literature showed that the timing of initiation of pulse methylprednisolone therapy is important. It is suggested that pulse methylprednisolone therapy should be considered if there is no response to two standard doses of IVIG treatment.
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Affiliation(s)
- Jeng-Juh Hung
- Department of Pediatrics, Chang Gung Children's Hospital, Kweishan, Taoyuan, Taiwan
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Yuan SM. Cardiac surgical procedures for the coronary sequelae of Kawasaki disease. Libyan J Med 2012; 7:19796. [PMID: 23226165 PMCID: PMC3514494 DOI: 10.3402/ljm.v7i0.19796] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 10/29/2012] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of this article is to make an evaluation on the clinical features of patients with Kawasaki disease who require a cardiac surgical procedure including coronary artery bypass grafting, coronary arterial aneurysmorrhaphy or heart transplantation. METHODS English literature of Kawasaki disease for cardiac surgery (1990-2011) was retrieved in the Pubmed database. The clinical features of the patient setting from the representative articles were collected and analyzed. RESULTS Patients with Kawasaki disease were very young, with some requiring a cardiac surgical procedure at a very early age. The interval between the onset and the surgical operation was 9.5±9.4 years. The prevalence of myocardial infarction and re-infarction was high. Giant aneurysm, critical stenosis with calcification and thrombus formation of the coronary arteries often warrant coronary artery bypass, heart transplantation or coronary arterial aneurysm plication. The left internal mammary artery to the left anterior descending coronary artery was the most commonly used graft in coronary artery bypass. Graft patency rate was 82.4% at 21.4±32.3 (range 0.1-252) month follow-up. The early and late mortalities of this patient setting were 0.6 and 3.0%, respectively. CONCLUSIONS Patients with Kawasaki disease may develop coronary artery lesions prone to aneurysmal formation with calcification and thrombus and may require coronary artery bypass at a very early age. With the left internal mammary artery as the first choice of bypass graft, the long-term patency and patient survival was satisfactory.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People's Republic of China.
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Paredes N, Mondal T, Brandão LR, Chan AKC. Management of myocardial infarction in children with Kawasaki disease. Blood Coagul Fibrinolysis 2010; 21:620-31. [DOI: 10.1097/mbc.0b013e32833d6ec2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.
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Manzar KJ, Padder FA, Conrad AR, Freeman I, Jonas EA. Acute Myocardial Infarction With Normal Coronary Artery: A Case Report and Review of Literature. Am J Med Sci 1997. [DOI: 10.1016/s0002-9629(15)40234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Manzar KJ, Padder FA, Conrad AR, Freeman I, Jonas EA. Acute myocardial infarction with normal coronary artery: a case report and review of literature. Am J Med Sci 1997; 314:342-5. [PMID: 9365338 DOI: 10.1097/00000441-199711000-00013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 17-year-old girl with no risk factors for coronary artery disease had acute myocardial infarction. She received thrombolytic therapy with tissue-type plasminogen activator. An extensive workup for the cause of myocardial infarction revealed protein S deficiency. Angiography showed normal coronary arteries. We speculate that the cause of myocardial infarction was coronary spasm or thrombus formation, which was successfully dissolved by thrombolytic therapy. This is the eighth case report of acute myocardial infarction in a patient with normal coronaries and protein S deficiency. We reviewed the literature concerning myocardial infarction and normal coronaries and protein S deficiency. This case report and review of the literature suggest the need to extend the concept of classic risk factors for coronary artery disease in young patients with myocardial infarction and normal coronary arteries.
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Affiliation(s)
- K J Manzar
- Division of Cardiology, Nassau County Medical Center, East Meadow, New York 11554, USA.
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Burns JC, Shike H, Gordon JB, Malhotra A, Schoenwetter M, Kawasaki T. Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol 1996; 28:253-7. [PMID: 8752822 DOI: 10.1016/0735-1097(96)00099-x] [Citation(s) in RCA: 208] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Kawasaki disease is an acute vasculitis of unknown etiology that predominantly affects children <5 years of age. Structural damage to the coronary arteries after the acute, self-limited illness is detected by echocardiography in approximately 25% of untreated patients. The long-term effects of the acute coronary arteritis are unknown. To define the spectrum of clinical disease in young adults that can be attributed to Kawasaki disease in childhood, we performed a retrospective survey of cases reported in the English and Japanese published data of adult coronary artery disease attributed to antecedent Kawasaki disease. The mean age at presentation with cardiac sequelae was 24.7 +/- 8.4 years (range 12 to 39) for the 74 patients identified with presumed late sequelae of Kawasaki disease. Symptoms at the time of presentation with cardiac sequelae included chest pain/myocardial infarction (60.8%), arrhythmia (10.8%) and sudden death (16.2%). These symptoms were precipitated by exercise in 82% of patients. One-third of the patients in whom a chest radiograph was taken had ring calcification. Angiographic findings included coronary artery occlusion (66.1%). Extensive development of collateral vessels was reported in 44.1% of patients. Autopsy findings included coronary artery aneurysms (100%) and coronary artery occlusion (72.2%). The acute vasculitis of Kawasaki disease can result in coronary artery damage and rheologic changes predisposing to thrombus formation or progressive atherosclerotic changes that may remain clinically silent for many years. Coronary artery aneurysms and calcification on chest radiography were unusual features in this group of patients. A history of antecedent Kawasaki disease should be sought in all young adults who present with acute myocardial infarction or sudden death.
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Affiliation(s)
- J C Burns
- Kawasaki Disease Research Program, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, 92093-0609, USA
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Alam S, Sakura S, Kosaka Y. Anaesthetic management for caesarean section in a patient with Kawasaki disease. Can J Anaesth 1995; 42:1024-6. [PMID: 8590491 DOI: 10.1007/bf03011076] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Kawasaki disease (KD) or mucocutaneous lymph node syndrome is an acute febrile illness affecting mainly children under four years of age. The most important clinical feature of this disease is coronary arteritis associated with aneurysms and thrombotic occlusions, which may lead to ischaemic heart disease or sudden death. It has now been more than 20 yr since its first description, and a number of survivors of childhood KD have reached child-bearing age. Despite the possible fatal outcome of this disease in adult patients with coronary artery manifestations, no information is available regarding the obstetrical anaesthetic management of patients with a history of KD. The purpose of this report is to describe the successful use of epidural anaesthesia in a patient with a history of KD undergoing Caesarean section and to discuss the anaesthetic considerations that should be given to adult survivors of childhood KD.
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Affiliation(s)
- S Alam
- Department of Anesthesiology, Shimane Medical University, Izumo, Japan
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