Follow-up of coronary artery lesions caused by Kawasaki disease and the value of coronary angiography

OBJECTIVE: To investigate the course of coronary artery lesions caused by Kawasaki disease, and the value of coronary angiography (CAG) and two-dimensional echocardiography (2-D Echo) in the evaluation and follow-up of coronary artery lesions. METHODS: Eighty seven patients with coronary artery lesions caused by Kawasaki disease from 1979 to 1997 were retrospectively analyzed. One hundred and sixty-seven CAGs were performed in 87 patients during follow-up. CAG was repeated every 1-3 years in each patient until complete regression was confirmed. 2-D Echo was performed before CAG each time. The longest period of follow-up was 16 years and 6 months. Patients were treated with aspirin or aspirin and warfarin. RESULTS: During follow-up, the coronary artery lesions regressed in 48/87 (55%) patients, however, they developed into severe coronary artery lesions in 6/87 (7%) patients in whom coronary artery bypass surgery was performed. The coronary artery aneurysm regressed in some patients, while stenotic lesions remained or developed. The ratio of coronary artery stenotic lesions to aneurysms increased progressively. This study showed that Echo diagnosis of coronary artery lesions has 'false positives' and 'false negatives'. Only 76% of coronary aneurysms and 18% of stenotic lesions could be found by 2-D Echo. No stenotic lesion could be found in distal segments of the coronary artery. CONCLUSIONS: Long term follow up revealed spontaneous regression occurred in 55% of patients and development into severe coronary artery stenosis in 7%. It is necessary to perform long-term follow-up in patients with coronary artery lesions caused by Kawasaki disease. 2-D Echo can not completely replace CAG during follow-up of coronary artery lesions caused by Kawasaki disease.

Epidemiologic features of Kawasaki disease in Shanghai from 2003 through 2007

Background The epidemiologic pictures of Kawasaki disease （KD） in Shanghai from 1998 through 2002 were reported while the current status of KD in the following five years remains unknown. Methods A questionnaire form and diagnostic guidelines for KD were sent to 50 hospitals providing pediatric medical care in Shanghai, China. All patients with KD diagnosed during January 2003 through December 2007 were recruited. Results In total, 1187 cases of KD were enrolled. The incidence of KD was 36.78 to 53.28 （mean 46.32±6.51） per 100 000 children under the age of 5 years between 2003 and 2007, which was higher than the year from 1998 to 2002 of （27.32±7.11） per 100 000, （t=4.406, P=0.002）. Ages at onset ranged from 12 days to 13.6 years （median 1.8 years）. It occurred more frequently in summer and spring. Coronary arterial lesions （CAL）, defined as ectasia or aneurysm, accounted for 19.8% （232 cases）. Flattened or inverted T wave was the most frequent finding （194 cases, 20.5%） by electrocardiogram. Intravenous gamma-globulin was administrated to 1028 cases （86.6%）. The occurrence of CAL seemed less frequent in the patients received gamma-globulin from day 5 to day 9 after the onset with the regimen of 1000 mg/kg once or 1000 mg/kg twice. Conclusions The incidence of KD was increasing in Shanghai. Treatment with intravenous gamma-globulin from day 5 to day 9 after the onset with the regimen of 1000 mg/kg once or 1000 mg/kg twice resulted in less coronary seauelae.