UZH-Logo

Maintenance Infos

Long-term follow-up of acute changes in corona artery diameter caused by Kawasaki disease: risk factors for development of stenotic lesions


Mueller, F; Knirsch, W; Harpes, P; Prêtre, René; Valsangiacomo Büchel, Emanuela R; Kretschmar, O (2009). Long-term follow-up of acute changes in corona artery diameter caused by Kawasaki disease: risk factors for development of stenotic lesions. Clinical Research in Cardiology, 98(8):501-507.

Abstract

OBJECTIVE: To investigate the long-term outcome of initially dilated/aneurysmatic coronary arteries in Kawasaki disease (KD) and to define risk factors for significant myocardial ischemia during follow-up, we retrospectively followed all pediatric patients with proven acute coronary changes due to KD in our institution. METHODS AND RESULTS: Since 1981, 38 children have been identified with coronary changes due to KD. The median age was 1.2 years (0.1-12.8). In 37 patients therapy with intravenous immunoglobulin was initiated within 9 days (1-30) after the beginning of KD. All received aspirin and three additionally received steroids. Median follow-up was 8.5 years (0.5-24.8). We defined two groups: A aneurysm/ectasia of the coronary artery < or =5.0 mm (n = 23) and B aneurysm size >5.0 mm (n = 15). During follow-up, all coronary aneurysms of group A regressed to normal size, whereas in 14 patients of group B (93%) the aneurysms persisted or even increased in size. Four patients of group B developed severe coronary stenosis at the proximal and/or distal end of the aneurysm and needed an intervention (endovascular balloon dilation and stent implantation (n = 2) or bypass surgery (n = 2)) after a median time interval of 9.8 years (1.0-15.6) after KD. They all had ECG changes preceding the intervention about 1 year in advance. Maximum aneurysm size >5 mm was a statistical significant predictive risk factor for myocardial ischemia. CONCLUSIONS: After KD, patients with a coronary aneurysm size >5.0 mm need close follow-up assessments because of an elevated risk for the development of coronary stenotic lesions. In case of new and even unspecific ECG changes, coronary imaging modalities (angiography, MRI) have to be considered. Therapy options vary from percutaneous catheter interventions to bypass surgery and have to be selected individually for each patient.

OBJECTIVE: To investigate the long-term outcome of initially dilated/aneurysmatic coronary arteries in Kawasaki disease (KD) and to define risk factors for significant myocardial ischemia during follow-up, we retrospectively followed all pediatric patients with proven acute coronary changes due to KD in our institution. METHODS AND RESULTS: Since 1981, 38 children have been identified with coronary changes due to KD. The median age was 1.2 years (0.1-12.8). In 37 patients therapy with intravenous immunoglobulin was initiated within 9 days (1-30) after the beginning of KD. All received aspirin and three additionally received steroids. Median follow-up was 8.5 years (0.5-24.8). We defined two groups: A aneurysm/ectasia of the coronary artery < or =5.0 mm (n = 23) and B aneurysm size >5.0 mm (n = 15). During follow-up, all coronary aneurysms of group A regressed to normal size, whereas in 14 patients of group B (93%) the aneurysms persisted or even increased in size. Four patients of group B developed severe coronary stenosis at the proximal and/or distal end of the aneurysm and needed an intervention (endovascular balloon dilation and stent implantation (n = 2) or bypass surgery (n = 2)) after a median time interval of 9.8 years (1.0-15.6) after KD. They all had ECG changes preceding the intervention about 1 year in advance. Maximum aneurysm size >5 mm was a statistical significant predictive risk factor for myocardial ischemia. CONCLUSIONS: After KD, patients with a coronary aneurysm size >5.0 mm need close follow-up assessments because of an elevated risk for the development of coronary stenotic lesions. In case of new and even unspecific ECG changes, coronary imaging modalities (angiography, MRI) have to be considered. Therapy options vary from percutaneous catheter interventions to bypass surgery and have to be selected individually for each patient.

Citations

9 citations in Web of Science®
11 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

0 downloads since deposited on 06 Mar 2010
0 downloads since 12 months

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2009
Deposited On:06 Mar 2010 15:15
Last Modified:05 Apr 2016 14:00
Publisher:Springer
ISSN:1861-0684
Publisher DOI:10.1007/s00392-009-0032-2
PubMed ID:19499164
Permanent URL: http://doi.org/10.5167/uzh-32149

Download

[img]
Filetype: PDF - Registered users only
Size: 1MB
View at publisher

TrendTerms

TrendTerms displays relevant terms of the abstract of this publication and related documents on a map. The terms and their relations were extracted from ZORA using word statistics. Their timelines are taken from ZORA as well. The bubble size of a term is proportional to the number of documents where the term occurs. Red, orange, yellow and green colors are used for terms that occur in the current document; red indicates high interlinkedness of a term with other terms, orange, yellow and green decreasing interlinkedness. Blue is used for terms that have a relation with the terms in this document, but occur in other documents.
You can navigate and zoom the map. Mouse-hovering a term displays its timeline, clicking it yields the associated documents.

Author Collaborations