Coronary artery aneurysms caused by Kawasaki disease in an adult:A case report and literature review

BACKGROUND Kawasaki disease(KD) is a self-limiting febrile illness and an acute vasculitis with an unknown origin.It predominantly affects children aged < 5 years.KD is the common cause of acquired heart disease in children.We here report a case of KD in an asymptomatic young female patient diagnosed with multiple coronary aneurysms with calcification.CASE SUMMARY A 29-year-old female patient admitted to Hangzhou First People’s Hospital with coronary artery abnormality identified for 1 wk.The patient was asymptomatic;however,chest computed tomography occasionally revealed strip-like dense shadows in the coronal sulcus.After coronary angiography and Doppler echocardiography,the final diagnosis was coronary artery aneurysms(CAAs) caused by KD.Although the patient was asymptomatic with no history of KD in childhood,the definitive diagnosis was CAAs caused by KD.The patient was administered anticoagulant,and surgical treatment was recommended.CONCLUSION KD potentially causes CAAs in 25% of untreated cases,primarily occurring in the proximal portions of the coronary arteries.

Coronary artery aneurysm:A review

Coronary artery aneurysm(CAA)is a clinical entity defined by a focal enlargement of the coronary artery exceeding the 1.5-fold diameter of the adjacent normal segment.Atherosclerosis is the main cause in adults and Kawasaki disease in children.CAA is a silent progressive disorder incidentally detected by coronary angiography,but it may end with fatal complications such as rupture,compression of adjacent cardiopulmonary structures,thrombus formation and distal embolization.The pathophysiological mechanisms are not well understood.Atherosclerosis,proteolytic imbalance and inflammatory reaction are involved in aneurysmal formation.Data from previously published studies are scarce and controversial,thereby the management of CAA is individualized depending on clinical presentation,CAA characteristics,patient profile and physician experience.Multiple therapeutic approaches including medical treatment,covered stent angioplasty,coil insertion and surgery were described.Herein,we provide an up-to-date systematic review on the pathophysiology,complications and management of CAA.

Coronary artery aneurysm combined with myocardial bridge:A case report

BACKGROUND Coronary artery aneurysm combined with myocardial bridge is a very rare clinical situation.The prognosis of this clinical situation is not yet clear.CASE SUMMARY A coronary artery aneurysm and myocardial bridge in the same segment of the coronary artery were found in a 54-year-old female patient who underwent coronary angiography and intravascular ultrasound examination.Through conservative treatment,the patient was discharged from the hospital smoothly,and she was in good condition during 5 mo of follow-up.CONCLUSION Coronary artery aneurysm combined with myocardial bridge seems to have a good prognosis,but due to the rarity of this clinical situation,further research and follow-up are needed.

Evaluation of neointimal coverage in patients with coronary artery aneurysm formation after drug-eluting stent implantation by optical coherence tomography

Background The vessel healing in patients with coronary artery aneurysms （CAA） that form after drug-eluting stent （DES） implantation is not clear. This study aims to assess the vessel healing in patients with CAA formation after DES implanation. Methods From June 2008 to August 2011, follow-up coronary angiography was conducted on 1160 patients who underwent percutaneous coronary intervention （PCI）. The average period of follow-up was about （18.95±13.05） months. A total of 175 patients who underwent DES implantation into de novo lesions and who underwent coronary angiography and optical coherence tomography （OCT） examination during follow-up were identified. Patients were divided into the CAA group （n=31） and non-CAA group （n=144） based on the results of the coronary angiography. The cardiac events including angina and acute myocardial infarction were noted; in addition, the neointimal thickness and the frequency of strut malapposition and strut uncoverage were also noted. Results A greater proportion of incomplete neointimal coverage （17.17% vs. 1.90%, P 〈0.001） and strut malapposition （18.20% vs. 1.38%, P 〈0.001） were observed in the CAA group. The neointimal thickness in the CAA group was significantly thinner than that in the non-CAA group （（146.6±94.8） μm vs. （192.5＋97.1）μm, P 〈0.001）, as detected via OCT. Patients with CAA formation had a higher frequency of cardiac events including angina pectoris （25.81% vs. 6.25%, P=0.001） and acute myocardial infarction （9.68% vs. 0.13%, P=0.002） and thrombosis （16.13% vs. 0.69%, P 〈0.001）. The longitudinal length of the CAA in the cardiac event group was significantly longer than in the no cardiac event group （（20.0±9.07） mm vs. （12.05±5.38） ram, P=0.005）. Conclusion CAA formation after DES implantation is frequently associated with cardiac events as a result of stent malapposition and incomplete neointimal coverage.

Incomplete Kawasaki disease complicated with acute abdomen: A case report

Kawasaki disease(KD)is an acute systemic vasculitis characterized by unknown etiology.CASE SUMMARY A 4.5-year-old boy developed an acute abdomen during the onset of incomplete KD.He still had persistent abdominal pain after undergoing exploratory laparotomy and appendectomy.Ultrasound examination at early onset revealed a giant coronary artery aneurysm.The patient developed a myocardial infarction and heart failure accompanied by respiratory and cardiac arrest.He underwent coronary artery revascularization and coronary artery bypass graft using an autologous internal mammary artery.After the operation,the cardiac output increased,and the symptoms of heart failure resolved.Follow-up evaluation at 1 mo after operation showed that the patient's cardiac function had restored to New York Heart Association standard Grade I heart failure,and normal growth was obtained.CONCLUSION Coronary artery revascularization and coronary artery bypass graft is an effective method for treating myocardial ischemia in children with KD complicated with giant coronary artery aneurysm.Nevertheless,some issues still need specific attention.

Epicardial radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmias during off-pump coronary artery bypass surgery

Background Left ventricular aneurysm （LVA） is one of the serious complications after acute myocardial infarction. We attempted to evaluate the preliminary efficacy of LVA repair combined with epicardial radiofrequency ablation for ventricular arrhythmia during off-pump coronary artery bypass grafting （OPCAB）.

Nursing care of 25 children with Kawasaki disease

Objective The aim of this study is to estimate the incidence and describe the diagnosis,treatment and nursing care of Kawasaki Disease among children in Guilin city,Guangxi Province,China.The study is also designed to assess clinical aspects of retrospection,management and outcome,specifically in relation to cardiac disease.Methods To retrospectively collected the clinical data of pediatric patients with Kawasaki's disease at the Affiliated Hospital of Guilin Medical University in China,which covered a two-year period from 2015 to 2016.Results During the two-year study period,a total of 25 cases of Kawasaki disease were reported in the hospitals,comprising of 11 boys and 14 girls(male-female ratio was 1∶1.27).The seasonal distribution showed a slightly higher incidence in spring and summer.The patients’mean age of onset was 2.78 years old.The average hospitalization days of patients were 8.08(range from 5 to18days).16 Kawasaki patients were diagnosed as bronchial pneumonia.Coronary arterial abnormalities were detected during follow up by UCG in 5 cases,but no coronary artery aneurysm was found.All 25 patients recovered and were discharged from the hospital.Conclusion Early treatment and proper nursing management are key issues to prevent the occurrence of coronary artery aneurysm in Kawasaki Disease patients.

Research progress on the correlation between S100protein family and Kawasaki disease with coronary artery aneurysm

Background Kawasaki disease(KD)is the systemic vasculitis with unknown cause.The S100 protein outside cells have an important effect on congenital and adaptive immunity,chemotaxis,white blood cell(WBC)and tumor cell invasion,tissue growth and repair.Recently,multiple works have investigated the value of S100 proteins as the predictive biomarker of KD.The most serious complication of KD is coronary artery aneurysm(CAA).KD is the most common cause of acquired heart disease among children within developed countries and a risk factor for myocardial infarction in early adulthood.Early treatment with intravenous immunoglobulin(IVIG)has been shown to reduce the risk of CAA in KD from 15%-25%to about 4%.S100 family proteins are calcium-binding proteins,some of which have been shown to have intracellular and extracellular functions associated with inflammation.Persistent elevation of S100 protein level(S100A8/A9 and S100A12)after IVIG therapy was reported in patients suffering CAA.In this paper,the role and mechanism of S100 protein family in CAA development in patients with KD were briefly reviewed.

Case report of a rare giant left anterior descending coronary artery aneurysm

Giant coronary artery aneurysm(CAA)is a rare condition,reportedly seen in 0.02-0.2%of patients undergoing coronary angiography.Asymptomatic in most cases,patients may present with angina pectoris,myocardial infarction,cardiac tamponade or sudden death.Given that the natural history of the CAA is still not predictable,the optimal treatment remains still debatable.In this case report,we present a male patient with a sudden non-exertional dyspnea and angina in a context of obesity,multiple large and medium vessels aneurysms and chronic kidney disease(CKD).A contrast CT detected a giant left anterior descending artery(LAD)CAA measuring 73 mm×47 mm,apparently compressing the circumflex(CX)and the pulmonary artery(PA).After undergoing a full(etiologic and aneurysm extension)panel of exams,the patient underwent a surgical exclusion of the giant CAA and a coronary artery bypass grafting(CABG)by using the left thoracic mammary artery(LITA).The hospitalization was uneventful,and the patient left the hospital completely asymptomatic.In conclusion,even in cases of giant coronary aneurysms,the treatment is surgical by excluding the aneurismatic sac and performing a surgical revascularization.

Corticosteroid Therapy Might be Associated with the Development of Coronary Aneurysm in Children with Kawasaki Disease

Background：Coronary artery lesions （CALs） are known to be the main complication in children with Kawasaki disease （KD）.Instead of intravenous immunoglobulin （IVIG）,corticosteroid therapy has been accepted to be used for children with KD who are unresponsive to IVIG.This study aimed to evaluate risk factors for CALs in children with KD.Methods：We retrospectively reviewed the clinical records of 2331 children with KD from January 2005 to December 2014.To identify the independent risk factors for CALs,multivariable logistic regression models were constructed using significant variables identified from univariate logistic regression analysis.Results：The incidence of CALs was 36.0% （840 of 2331）,including 625 （26.8%） coronary artery dilations and 215 （9.2%） coronary artery aneurysms （CAAs）.Multivariable logistic regression analysis identified that male,incomplete KD,longer fever duration,and C-reactive protein （CRP） 〉 100 mg/L were independent risk factors for coronary artery dilatations.On the other hand,male,incomplete KD,longer fever duration,prolonged days of illness at the initial treatment,corticosteroid therapy,sodium ≤133 mmol/L,and albumin 〈35 g/L were the independent risk factors for CAAs.In addition,corticosteroid therapy,prolonged days of illness at the initial treatment,and albumin 〈35 g/L were the independent risk factors for giant CAAs.Conclusions：CALs might be associated with male sex,incomplete KD,longer fever duration,prolonged days of illness at the initial treatment,albumin 〈35 g/L,sodium ≤ 133 mmol/L,CRP 〉 100 mg/L,and corticosteroid therapy.Corticosteroid therapy was an independent risk factor for CAAs and giant CAAs.Thus,corticosteroids should be used with caution in the treatment of KD with the risk for CALs.

Very late coronary aneurysm formation with subsequent stent thrombosis secondary to drug-eluting stent

Drug-eluting stents have changed the practice in interventional cardiology. With the widespread use of these stents important safety concerns regarding stent thrombosis and formation of coronary artery aneurysm have been expressed. While the majority of attention was focused on stent thrombosis, the formation of coronary aneurysm was only described in anecdotal reports. We report on a patient who suffered from very late stent thrombosis in association with coronary artery aneurysm formation secondary to drug-eluting stent but not to bare-metal stent.

Influence of morphology and hemodynamics on thrombosis in kawasaki disease patients

Kawasaki Disease(KD)patients with co-occurrent coronary artery aneurysms(CAAs)are prone to thrombosis.This study explores the thrombotic influence of morphology and hemodynamics in KD patients with CAAs.Patient-specific computed tomography angiogram images of 9 patients were used to rebuild coronary models(including 23 aneurysms;10 in thrombosed group,and 13 in non-thrombosed group)and perform computational simulations to obtain the hemodynamic parameters.The thrombosed and non-thrombosed groups were compared in terms of six parameters,namely,the maximum diameter(D_(max)),aspect ratio(R_(l/d)),shape,time-averaged wall shear stress(TAWSS),oscillatory shear index(OSI),and relative residence time(RRT).The results showed that:(1)In thrombosed aneurysms,there were several vortex structures(eddy zone),of which the position changed continuously in a cardiac cycle.In non-thrombosed aneurysms,the streamlines showed a large streaming zone.(2)Abnormal hemodynamic areas of aneurysms with thrombosis tended to appear in the same region(especially the proximal and near myocardial side of aneurysms).(3)In the non-thrombosed group,there was a correlation between the morphological and hemodynamic parameters.In thrombosed aneurysms,the flow pulsatility has a significant impact on the flow pattern.The thrombosed coronary aneurysms exhibited more risk factors and the co-location of hemodynamic abnormalities was consistent with the position of thrombosis.A score of risk factors could provide the thrombotic information of coronary aneurysms,which might be helpful for long-term clinical management of KD patients.

Extracardiovascular injury complications in Kawasaki disease

Importance:Patients with Kawasaki disease(KD)experience various extracardiovascular injury complications,which may affect their outcomes.Objective:To investigate the incidence and clinical characteristics of extracardiovascular complications in children with KD.Methods:The clinical data of patients diagnosed with KD in the First Affiliated Hospital of Guangxi Medical University from January 2003 to January 2021 were reviewed.The clinical characteristics and extracardiovascular complications were compared among patients stratified by age,intravenous immunoglobulin(IVIG)therapy responsiveness,and coronary status.Results:A total of 511 patients with KD were included,357(69.9%)were aged 1–5 years.Children aged<1 year(21.5%)and boys(70.8%)were more likely to have coronary artery lesions(CALs).The incidence of incomplete KD was lowest in 1–5-year-old patients(19.6%).Involvement of the hematological system gradually decreased with age(<1 year,51.8%;1–5 years,36.7%;>5 years,29.5%),whereas the involvement of the joints gradually increased with age(<1 year,2.7%;1–5 years,6.2%;>5 years,20.5%).Nervous system involvement was more common in IVIG non-responders(15.7%[13/83]vs.5.4%[23/428],P=0.001).However,there were no significant differences in extracardiovascular injury complications between patients with or without CALs.Interpretation:KD can involve multiple organ injuries as well as cardiovascular complications,and nervous systerm involvement may be more common in patients unresponsive to IVIG.