Congenital anomalies of coronary artery misdiagnosed as coronary dilatations in Kawasaki disease:A clinical predicament

BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities(CAAs)on 2DE.METHODS Records of children diagnosed with KD,who underwent computed tomography coronary angiography(CTCA)at our center between 2013-2023 were reviewed.We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA.Findings of CTCA and 2DE were compared in these 3 children.RESULTS Of the 241 patients with KD who underwent CTCA,3(1.24%)had congenital coronary artery anomalies on CTCA detected incidentally.In all 3 patients,baseline 2DE had identified CAAs.CTCA was then performed for detailed evaluation as per our unit protocol.One(11-year-boy)amongst the 3 patients had complete KD,while the other two(3.3-year-boy;4-month-girl)had incomplete KD.CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus[misinterpreted as dilated left main coronary artery(LCA)on 2DE],single coronary artery(interpreted as dilated LCA on 2DE)and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery.The latter one was subsequently operated upon.CONCLUSION CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies.Relying solely on 2DE may not be sufficient in such cases,and findings from CTCA can significantly impact therapeutic decision-making.

Employing a random forest model to forecast the likelihood of coronary artery lesions in Kawasaki disease: a study centered on four biomarkers

Background:Kawasaki disease is an acute immune vasculitis,which is more common in children under 5 years old.Kawasaki disease mainly affects the cardiovascular system,especially the coronary arteries.Once coronary artery damage occurs,it can significantly impact the patient’s prognosis.Therefore,in some countries and regions,Kawasaki disease has become a common acquired heart disease.Methods:First,univariate analysis was conducted on each predictive factor.Then,Least Absolute Shrinkage and Selection Operator and random forest algorithms were used to screen all predictive factors,and the prediction model was evaluated using receiver operating characteristic curve,calibration curve,and Decision Curve Analysis.Results:This study,based on data from 228 Kawasaki disease patients,utilized a random forest model to identify four predictive factors:white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count.These factors were used to construct a prediction model,which achieved an area under the curve of 0.743.Conclusions:We developed a forest plot based on white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count to effectively predict the occurrence of coronary artery lesions in Kawasaki disease.

A Meta-analysis of the Biomarkers Associated with Coronary Artery Lesions Secondary to Kawasaki Disease in Chinese Children

The biomarkers associated with coronary artery lesions （CAL） secondary to Kawasaki disease （KD） in Chinese children were investigated by using Meta-analysis. We searched documents published from January 1997 to December 2009 from medical electronic databases. According to inclusion and exclusion criteria, eligible full-text papers were identified. We conducted a comprehensive quantitative analysis by using Stata10.0 statistical software package to assess the heterogeneity among the documents, calculated the summary effect and analyze publication bias and sensitivity. A total of 92 documents and 16 biomarkers were identified. All documents were case-control studies, and included 2398 patients in CAL group and 5932 patients in non-CAL （NCAL） group. The Meta-analysis showed that the levels of platelet count, platelet hematocrit （PCT）, neutrophils count, platelet distribution width （PDW）, mean platelet volume （MPV）, erythrocyte sedimentation rate （ESR）, cardiac troponin Ⅰ （cTnI）, and endothelin-1 （ET-1） in CAL group were significantly higher than those in NCAL group, and serum albumin （Alb） and hemoglobin （Hb） levels were significantly lower in CAL group （all P〈0.05）. White blood cell （WBC） count, serum sodium, matrix metalloproteinase 9 （MMP-9）, total cholesterol （TC）, hematocrit （HCT） and CD3＋T lymphocytes percentage had no statistically significant difference between the two groups. In conclusion, our results indicated that the 10 biomarkers including platelet count, neutrophils count, PCT, PDW, MPV, ESR, cTnI, ET-1, Alb and Hb were associated with CAL, and may be involved in the pathogenesis of CAL. The biomarkers of WBC count, serum sodium, MMP-9, TC, HCT, and CD3＋T lymphocytes percentage bore no relationship with the development of CAL among Chinese children with KD.

Reevaluation of the Efficacy of Intravenous Gammaglobulin in the Prevention and Treatment of Coronary Artery Lesion in Kawasaki Disease

In order to objectively evaluate the efficacy of intravenous gammaglobulin (IVIG) in the prevention and treatment of coronary artery lesion (CAL) in Kawasaki disease (KD) and the related factors influencing the IVIG efficacy, 314 children with KD were reviewed retrospectively and comparatively and were divided into IVIG plus aspirin group and ASA group. The occurrence and restoration of CAL in these two groups as well as many laboratory and clinical indexes including average hospital stay (days), total fever duration, defervescence time, platelet count, erythrocyte sedimentation rate, C reactive protein etc. were observed. The incidence of CAL was 39.5 % in the children with KD. In the IVIG+ASA group, the incidence of CAL was 34.3 % and 56.0 % in ASA group respectively (P<0.001). The incidence of CAL was reduced in the group in which 2.0 g/kg or 1.0 g/kg IVIG was administered as compared with the group in which IVIG was administered at a dose ≤0.6 g/kg or ≥3.0 g/kg (P<0.05). CAL occurred less frequently when IVIG was administered at 3-10 days of the course than that when IVIG was administered ≤3 days or >10 days (P<0.05). About 13.4 % of the CAL treated with IVIG was not recovered at the 12 th month of the course, mostly in the groups in which only ASA was administered and IVIG treatment was started 10 days later. The hospital stay (days), defervescence time, total fever duration, platelet count, erythrocyte sedimentation rate and C reactive protein were significantly reduced in IVIG+ASA group as compared with those in the ASA group (P<0.05). IVIG treatment can remarkably shorten the course of patients with KD and decrease the incidence of CAL, but the efficacy of IVIG in the prevention and treatment of KD disease is not as expected by people, therefore, reevaluation of the practical efficacy of IVIG is required.

Echocardiography in Diagnosis and Prevention of the Coronary Artery Lesions in Kawasaki Disease

Kawasaki disease (muco-cutaneous lymph node syndrome, MCLS) was first reported by Kawasaki in 1967. It was characteried by nonvascular polymorphous rash, fever, ulcer in oral mucosa, edema of hands of feet, cervix lymphadenopathy and desquamations in peripheral extremities. Because of unknown pathogens, no lab examination was available as a single easily recognized diagnostic marker; the diagnosis is

Imperative for long-term management and surveillance in Kawasaki disease

Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.

Risk of coronary arterial lesions in immunoglobulin resistant Kawasaki disease

Objective: High-dose intravenous immunoglobulin (IVIG) decreases the risk for development of coronary arterial lesions (CAL) in Kawasaki disease (KD) while patients resistant to IVIG have higher risk. This study is aimed to investigate an additional therapy affects the risk for CAL in IVIG resistant KD. Design: The information from 11,510 children with KD was collected by the nationwide survey (2003-2004) in Japan. The secondary therapeutic strategies for IVIG resistant KD were an additional IVIG dose, steroids or both. The incidence of CAL was compared among 4 groups: G1, children responded to initial IVIG;G2, IVIG resistant patients receiving an additional IVIG dose;G3, IVIG resistant patients receiving additional steroids;G4, IVIG resistant patients receiving an additional IVIG dose plus steroids. CAL was assessed at 30th day of illness using ultrasound echocardiography. Results: 2229 patients (19.4%) were resistant to initial IVIG. Incidence of CAL was significantly lower in children responding to initial IVIG than in IVIG resistant patients (1.9% and 11.0%, respectively;odd’s ratio 6.3). The incidences of CAL in an each additional therapy group were as follows: G2: 6.7%, G3: 9.7%, G4: 22.2%. The risk for CAL was significantly higher in G4 as compared with G2 and G3. Giant aneurysmal formation (GA) was more frequently developed in G3 and G4 consisting of the patients receiving steroids (G1: 0.03%, G2: 0.63%, G3: 4.3%, G4: 3.7%). Conclusion: The incidence of CAL was considerably high in IVIG resistant KD and an additional therapy by steroids may increase the risk for GA.

Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease

Coronary artery abnormalities are the most important complications in children with Kawasaki disease(KD).Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD.However,it has inherent limitations with regard to evaluation of mid and distal coronary arteries and,left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group.Catheter angiography(CA)is invasive,has high radiation exposure and fails to demonstrate abnormalities beyond lumen.The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems.In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children.Computed tomography coronary angiography(CTCA)can be performed during acute as well as convalescent phases of KD.It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.

Lipid profile in children with coronary artery disease in Sindh,Pakistan

AIM:To evaluate lipid profile in children with coronary artery disease(CAD)in Hyderabad,Sindh,Pakistan.METHODS:The study included 100 children(6-15years),of which 43 were children of young parents(one or both)with recognized CAD,while the other 57 were children with no evidence of CAD(controls).All were evaluated for fasting blood lipid profile.Blood samples were collected from patients with CAD and healthy controls and analysis of the levels of lipid profile were carried out using a kit method on Microlab 300.RESULTS:Children with CAD had significantly higher levels of total serum cholesterol and triglycerides and decreased levels of high density lipoprotein and low density lipoprotein compared to children in the control group.Systolic and diastolic blood pressures were significantly higher,without any significant difference.CONCLUSION:CAD risk factors are significant regarding abnormal lipid levels.Genetic tendency seems to be important in the development of CAD in children.

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.

OPCAB (Off Pump Coronary Artery Bypass) for Kawasaki Disease

We hereby report a case of Kawasaki disease in a 32 year old male, with giant aneurysm of both coronary arteries and severe LV (left ventricular) dysfunction who underwent OPCAB (off pump coronary artery bypass grafting) two years ago. He presented with acute myocardial infarction of his anterior wall of left ventricle. He was stabilised with medical management and was taken up for surgery when his enzymes became normal. His LV function had improved over the time and now has a good ejection fraction.

Radiation dose analysis of computed tomography coronary angiography in Children with Kawasaki disease

BACKGROUND There is evolving role of computed tomography coronary angiography(CTCA)in non-invasive evaluation of coronary artery abnormalities in children with Kawasaki disease(KD).Despite this,there is lack of data on radiation dose in this group of children undergoing CTCA.AIM To audit the radiation dose of CTCA in children with KD.METHODS Study(December 2013-February 2018)was performed on dual source CT scanner using adaptive prospective electrocardiography-triggering.The dose length product(DLP in milligray-centimeters-mGy.cm)was recorded.Effective radiation dose(millisieverts-mSv)was calculated by applying appropriate age adjusted conversion factors as per recommendations of International Commission on Radiological Protection.Radiation dose was compared across the groups(0-1,1-5,5-10,and>10 years).RESULTS Eighty-five children(71 boys,14 girls)with KD underwent CTCA.The median age was 5 years(range,2 mo-11 years).Median DLP and effective dose was 21 mGy.cm,interquartile ranges(IQR)=15(13,28)and 0.83 mSv,IQR=0.33(0.68,1.01)respectively.Mean DLP increased significantly across the age groups.Mean effective dose in infants(0.63 mSv)was significantly lower than the other age groups(1-5 years 0.85 mSv,5-10 years 1.04 mSv,and>10 years 1.38 mSv)(P<0.05).There was no significant difference in the effective dose between the other groups of children.All the CTCA studies were of diagnostic quality.No child required a repeat examination.CONCLUSION CTCA is feasible with submillisievert radiation dose in most children with KD.Thus,CTCA has the potential to be an important adjunctive imaging modality in children with KD.

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.

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR COMPLICATED CORONARY ARTERY LESIONS

Objective To research the effect of percutaneous transluminalcoronary angioplasty (PTCA) on treating complicated artery lesions.Methods Type B or type C of complicated coronary artery lesionswere confirmed by selective coronary angingraphy in 16 cases with coronaryheart disease.Gruentzig’s method was used in carring out PTCA.Results Fifteen of sixteen and thirty-two of thirty-five parts ofcoronary artery lesions were dilated successfully,the success rate was 93.7%and 88.5%,respectively.In failed four parts of PTCA,three parts werebecause of the guilding wire or the balloon failed to pass the narrow arterythrough,the other one was unable to be performed for the occurrencedsevere arrthymia during the procedure.Four stents were implantend foracute accident.Symptoms of the successful cases were improved ordisappeared after PTCA.Conclusion PTCA is also fit in treating complicated coronary arterylesions and has a better therapeutic effect,but it has more complications andrun more risks relatively.

Association of MPO gene polymorphism with coronary artery injury and therapeutic effect of IVIG combined with heparin in children with KD

Objective: To investigate the relationship between the polymorphism of myeloperoxidase (MPO) gene and coronary artery injury in children with Kawasaki disease (KD) and the therapeutic effect of human immunoglobulin (IVIG) combined with heparin. Methods: A total of 78 KD children and 65 normal children treated in our hospital from April 2016 to February 2018 were selected as the s study ubjects. They were divided into coronary artery injury group (36 cases) and non-coronary artery injury group (42 cases) according to whether or not coronary artery injury occurred. Polymerase chain-endonuclease fragment (PCR-RFLP) was used to determine the distribution of single nucleotide polymorphism (SNP) locus polymorphism of MPO gene. Clinical data of children were collected to compare the distribution of genotype frequency and allele frequency among different groups. All KD children were treated with IVIG combined with low molecular weight heparin calcium subcutaneously. The correlation between MPO gene polymorphism and therapeutic effect was analyzed. Results: The frequencies of three genotypes (AA, AG and GG) in KD group were 1.28%, 20.51% and 78.21% respectively, while those in control group were 9.23%, 63.08% and 23.08% respectively. There was a significant difference between the two groups;the allele frequency of G in KD group was 88.46%, significantly higher than 76.92% in control group. The frequency distribution of each genotype in coronary artery injury group was significantly different from that in non-coronary artery injury group. The frequency of G allele in coronary artery injury group was significantly higher than that in non-coronary artery injury group. The total effective rate of KD group was 75.64%. The total effective rate of AG+AA genotype and GG genotype was 94.12% and 70.49%, respectively. The difference was statistically significant. There was no significant difference in coronary artery diameter between different genotypes before treatment, and after treatment, the GA+AA genotype's coronary artery diameter was significantly reduced compared with GG genotype's;the total fever time, the time of congestion and edema subsidence, the time of lymphadenopathy subsidence in GA+AA genotype were significantly shorter and those in the GG genotype. Conclusion: The SNP polymorphism of MPO gene may be related to the occurrence of coronary artery injury in children with KD, and G allele may be a risk factor. In addition, the polymorphism of MPO gene is associated with the efficacy of IVIG combined with heparin in the treatment of KD, which may be an effective predictor of the efficacy of IVIG combined with heparin.

Out-of-hospital cardiac arrest in a young adult survivor with sequelae of childhood Kawasaki disease: A case report

BACKGROUND Kawasaki disease(KD)is an acute type of systemic vasculitis involving small to medium-sized muscular arteries and outbreaks during childhood.KD can cause myocardial ischemia,infarction,and sudden cardiac arrest.We present a case of a young adult survivor of out-of-hospital cardiac arrest as late KD sequelae.CASE SUMMARY A 29-year-old man with presumed acute KD history at the age of 5 suddenly lost consciousness while jogging and was diagnosed a sudden cardiac arrest by an emergency doctor.After about 10 min cardiopulmonary resuscitation,return of spontaneous circulation was achieved,and the patient was transferred to our hospital.A coronary computed tomography angiogram and coronary angiography revealed extensive calcifications of left anterior descending and right coronary artery aneurysms.The patient was an active individual who took exercise regularly and claimed no previous symptoms of chest pain or shortness of breath on exertion.The most possible cause of his sudden cardiac arrest could be presumed as a thrombus within the coronary artery aneurysms.After that,a thromboembolism induced extensive ischemia,and this ischemia-induced arrhythmia led to a cardiac arrest.CONCLUSION Few patients who suffer a late sequela of KD can survive from out-of-hospital cardiac arrest.Medications,surgical intervention,and active follow-up are extremely important for this patient to prevent occurrence of adverse events in the future.

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.

Treatment Options for Refractory Kawasaki Disease

Kawasaki Disease (KD) is a self-limiting systemic vasculitis common among children under five years of age. Diagnosis of the disease is made primarily from the clinical features presented during the illness. Coronary artery aneurysm (CAA) is the main complication of this disease which can be prevented largely by the early diagnosis and administration of IVIG (Intravenous Immunoglobulin). Even with first dose of IVIG up to 10% - 20% of patients develop refractory Kawasaki Disease, i.e., remain unresponsive to initial IVIG treatment. Second dose of IVIG is recommended treatment for refractory Kawasaki Disease but other alternative treatments are also being considered to lower the risk of complications. Different drugs are still in trial phase and some others have limited studies on larger population. Most of the study reports that involved newer drugs have limited patients or are from single centers which are very hard to apply to larger population. We will review general treatment approach in refractory Kawasaki disease.

Drug-coated balloons for treating de novo lesions in large coronary vessels:A case report

BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug-coated balloons(DCB)in treating acute coronary artery occlusion and in preventing restenosis,there has been limited exploration on the use of DCB in treating de novo lesions in large vessels.Currently,DCB are only recommended for patients with small vessel lesions and in-stent restenosis lesions,those at high risk of bleeding,and other special groups of patients.CASE SUMMARY This report presents a case of successful drug-coated balloon treatment of de novo lesions in large coronary vessels.Postoperatively,the patient demonstrated favorable recovery,with subsequent examination results revealing no significant differences from the previous examination.CONCLUSION The successful treatment of the patient in our case highlights the potential of DCB in the treatment of de novo lesions in large coronary vessels.

Biomarkers of intravenous immunoglobulin resistance and coronary artery lesions in Kawasaki disease

Background Currently,there are no reliable indicators for predicting intravenous immunoglobulin resistance and coronary artery lesions in the early stage of Kawasaki disease.Methods A total of 300 patients with Kawasaki disease were studied retrospectively.Laboratory data were compared between the intravenous immunoglobulin resistant (29 patients) and responsive groups,and between the groups with coronary artery lesions (48 patients) and without coronary artery lesions.Results The intravenous immunoglobulin resistant group had significantly higher D-dimer,globulin,interleukin-6 and serum ferritin levels in comparison to the intravenous immunoglobulin responder group.D-dimer level had a sensitivity of 87.0% and a specificity of 56.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 1.09 mg/L.Globulin had a sensitivity of 62.1% and a specificity of 82.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 34.7 g/L.Serum ferritin level had a sensitivity of 42.9% and a specificity of 88.8% for predicting intravenous immunoglobulin resistance at a cutoff point of 269.7 ng/mL.The patients with coronary artery lesions had higher D-dimer and tumor necrosis factor-α level.D-dimer level had a sensitivity of 50% and a specificity of 78.6% for predicting coronary artery lesions at a cutoff point of 1.84 mg/L.Based on analysis by multivariate logistic regression,serum ferritin and globulin were independent risks for intravenous immunoglobulin resistance,D-dimer was independent risk for coronary artery lesions.Conclusions Elevated serum ferritin,globulin and D-dimer levels are significantly associated with intravenous immunoglobulin resistance in Kawasaki disease.Moreover,serum D-dimer is significantly increased in Kawasaki disease with coronary artery lesions.