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

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• 作者：John B. Gordon ; MD^a ; ^{jgordon552@mac.com" class="auth_mail" title="E-mail the corresponding author} ; Lori B. Daniels ; MD^b ; Andrew M. Kahn ; MD^b ; Susan Jimenez-Fernandez ; MD^c ; Matthew Vejar ; BS^c ; Fujito Numano ; MD^c ; Jane C. Burns ; MD^c
• 关键词：claudication ; coronary artery aneurysm ; pediatric acquired heart disease ; percutaneous coronary intervention ; vasculitis
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：11 April 2016
• 年：2016
• 卷：9
• 期：7
• 页码：687-696
• 全文大小：1468 K

文摘

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.