Risk factors of non-sustained ventricular tachycardia by technetium-perfusion imaging in patients with coronary artery lesions caused by Kawasaki disease

Myocardial Functional Imaging in Pediatric Nuclear Cardiology

The role of nuclear medicine in pediatric cardiology has grown rapidly over the years, providing useful functional and prognostic information and playing a complementary role to morphological imaging in the evaluation of myocardial perfusion, cardiovascular inflammation and infections, and cardiac sympathetic innervation. The aim of this narrative review is to summarize and highlight the most important evidence on pediatric nuclear cardiology, describing clinical applications and the possibilities, advantages, and limitations of nuclear medicine techniques. Moreover, a special focus will be given to the minimization of radiation exposure in pediatric nuclear cardiology imaging, a critical topic in children.

Clinical Course and Outcomes in Patients with Left Ventricular Dysfunction Due to Myocardial Infarction After Kawasaki Disease

Long-term outcomes of patients with left ventricular dysfunction after Kawasaki disease (KD) remain unknown. The clinical course of 37 patients (29 males 8 females) with left ventricular ejection function (LVEF) less than 45% after KD since 1978 was retrospectively investigated. Cardiac events in this study were defined as admissions because of heart failure, fatal ventricular arrhythmias, heart transplantation, and death. Their ages when evaluated ranged from 1 to 70 years (median 35 years). The onset of KD ranged from 2 months to 20 years (median 21 months). All patients had bilateral coronary artery lesions, and multi-vessel occlusion occurred in 31 patients (84%). Previous myocardial infarction (MI) was found in 28 patients (76%). The interval from the onset of acute KD to the initial MI ranged from 15 days to 25 years (median 3 months). Reperfusion therapy was successful in 6 patients (30%), and coronary artery bypass grafting was performed in 23 patients (62%). Non-sustained ventricular tachycardia and fatal ventricular arrhythmias were detected in 11 patients and 22 patients, respectively. There were 15 deaths (41%). The 20-year and 50-year survival rates after KD were 84% (95% CI 67-92) and 54% (34-73), respectively (n = 37). The 30-year cardiac event-free rate after the detection of low LVEF was 42% (95% CI 27-59). The cutoff point of the left ventricular end-diastolic dimension for cardiac events was 65 mm. Patients with low LVEF had fatal ventricular arrhythmias and a worsening of their ischemic cardiomyopathy after 30 years of age and their outcomes were poor.

Two females with coronary artery occlusion caused by presumed Kawasaki disease would have delivered without recognition of ischaemic heart disease

We report two females with coronary artery occlusion caused by presumed Kawasaki disease that delivered children without any special treatment. After a 58-year-old female had ventricular tachycardia, a giant coronary artery aneurysm with calcification at the bifurcation of the left coronary artery and segmental stenosis of the right coronary artery were pointed out by CT angiography. She had an episode of sepsis when 3 years old. Further, she remembered chest pain during sleep after that episode. She had delivered twice without any complication during her 20s. Her diagnosis was undiagnosed coronary artery lesions caused by presumed Kawasaki disease and a previous myocardial infarction, and she underwent radiofrequency catheter ablation and implantable cardioverter defibrillator implantation. The other 48-year-old female was accidentally discovered to have coronary artery calcification on CT, while experiencing pneumonia. Her CT angiograms revealed a right coronary artery occlusion and coronary artery calcification at segments 1, 6, and 11. She had a history of "scarlet fever" before 12 months. Premature ventricular contractions were detected, while delivering her first child when 31 years old. However, she was not diagnosed as ischaemic heart disease and delivered twice by a vaginal delivery without any complication. Current guidelines recommend systemic anti-coagulation and anti-platelet therapy for all patients with giant aneurysms resulting from Kawasaki disease in childhood. The two women reported here were fortunate not to have had complications during pregnancy and delivery despite their severe coronary artery aneurysms, which were unrecognised clinically until later in life. They were lucky cases.