Dilated coronary arterial lesions in the late period after Kawasaki disease

Abstract

Objectives: There are two types of late coronary dilated lesions after Kawasaki disease: new aneurysms and expanding aneurysms. The development of coronary dilated lesions late after Kawasaki disease was investigated.

Methods: Between 1978 and 2003, 562 patients with coronary arterial lesions underwent selective coronary angiography on at least two occasions.

Results: Of the 562 patients studied, 17 new dilated or expanding lesions were found in 15 patients (3%, 11 boys, four girls). The time of detection of new aneurysms after Kawasaki disease ranged from 1.9-19.2 years (median 11.4 years) and their diameters ranged from 2.0-6.5 mm (median 4.4 mm). Thirteen new aneurysms occurred in vessels in which previous aneurysms had regressed and all new aneurysms were associated with localised stenosis. A new aneurysm at the bifurcation or in the branches was seen in 14 (93%) and 13 were eccentric (87%). Of two expanding aneurysms, one involved the right coronary artery in one patient and the other the left anterior descending coronary artery. One expanding aneurysm increased from 4.4 mm to 19.5 mm over 17 years, and the other expanding aneurysm increased from 10 mm to 15 mm in one year.

Conclusions: Neither new nor expanding aneurysms have caused cardiac events. New aneurysms often develop as a pre-stenotic or post-stenotic dilatation secondary to localised stenosis. New and expanding aneurysms may be caused by haemodynamic factors in addition to the abnormality of the coronary arterial wall after severe acute vasculitis. Coronary arterial wall abnormalities were stenosis as well as, rarely, dilatation of the vessels in the late period. It is important to recognise that the changes of the coronary arterial wall persist late after regression of a large aneurysm.

Figure 1

New aneurysm at bifurcation. Angiograms at (left) 8 years and (right) 7 years.

Figure 2

New aneurysm with severe localised stenosis that developed as a post-stenotic dilatation. Angiograms at (top) 2 years, (middle) 7 years, and (bottom) 10 years. The angiogram showed a new aneurysm with severe localised stenosis.

Figure 3

Pressure gradient at localised stenosis estimated by Doppler echocardiography. (Top) Echocardiogram before coronary artery bypass grafting (CABG) at 10 years. The velocity at the localised stenosis was 2.8 m/s. (Bottom) Echocardiogram after CABG. The velocity at the localised stenosis was 1.0 m/s.

Figure 4

New aneurysm related to branching portion. Angiograms at (top) 5 years, (middle) 2 years, and (bottom) 19 years.

Figure 5

Intravascular ultrasound findings of a new aneurysm.

Figure 6

New aneurysm that developed as a pre-stenotic dilatation. Angiograms (top) two months, (middle) nine years, and (bottom) 14 years after onset.

Figure 7

Angiographic follow up of an expanding aneurysm in a patient who had Kawasaki disease at the age of 18 months. Angiograms at (A) age 22 months (aneurysm diameter 7.8 mm), (B) 2 years 9 months (4.4 mm), (C) 10 years (9.6 mm), (D) 14 years (16.3 mm), and (E) 20 years (19.5 mm).