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Case Reports
. 2022 Feb 12;22(1):85.
doi: 10.1186/s12887-022-03151-2.

Myocardial infarction due to thrombotic occlusion despite anticoagulation in Kawasaki disease - a case report

Diana van Stijn  1 , Nikki J Schoenmaker  2 , R Nils Planken  3 , Dave R Koolbergen  4 , Samantha C Gouw  5 , Taco W Kuijpers  6 , Nico A Blom  7 , Irene M Kuipers  7
Affiliations
Case Reports

Myocardial infarction due to thrombotic occlusion despite anticoagulation in Kawasaki disease - a case report

Diana van Stijn et al. BMC Pediatr. .

Abstract

Background: Kawasaki disease (KD) is a pediatric vasculitis. Mainly the coronary arteries become affected due to acute inflammation and formation of coronary artery aneurysms (CAAs) can occur. The larger the CAA, the higher the risk for clinical complications and major adverse cardiac events, as the blood flow changes to vortex or turbulent flow facilitating thrombosis. Such patients may develop life threatening thrombotic coronary artery occlusion and myocardial ischemiaunless anti-platelet and anti-coagulation therapy is timely initiated.

Case presentation: We present a unique case of a 5-year-old girl with KD associated giant CAAs suffering from myocardial ischemia due to acute progressive thrombus growth despite intensive anticoagulation treatment (acetylsalicylic acid, acenocoumarol and clopidogrel) after 21 months of onset of disease. Thrombus growth continued even after percutaneous coronary intervention (PCI) with thrombolytic treatment and subsequent systemic thrombolysis, finally causing lasting myocardial damage. Acute coronary artery bypass grafting (CABG) was performed, although technically challenging at this very young age. Whereas myocardial infarction was not prevented, follow-up fortunately showed favorable recovery of heart failure.

Conclusions: Anticoagulation and thrombolysis may be insufficient for treatment of acute coronary syndrome in case of impending thrombotic occlusion of giant coronary aneurysms in KD. Our case demonstrates that a thrombus can still continue to grow despite triple anticoagulation therapy and well-tailored cardiovascular follow-up, which can be most likely attributed to the state of low blood flow inside the aneurysm.

Keywords: Antiplatelet and anticoagulant drugs; Clopidogrel resistance; Coronary artery aneurysms; Imaging; Thrombosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Timeline of the first 2 years after onset of disease
Fig. 2
Fig. 2
Giant CAA (arrow) in LAD with thrombus (dotted arrow) depicted by echocardiography (A) and cCTA (B + C). C A reconstruction of the full length of the left main coronary artery. Echocardiography (A) and cCTA (B) showing thrombus (dotted arrow) in giant CAA with a luminal diameter of 13 mm, equivalent to a Z score of 34 (arrow) in LAD
Fig. 3
Fig. 3
Thrombus growth depicted by echocardiography. A Thrombus (*) in LAD. B Thrombus (*) growth in the course of 4 days in LAD
Fig. 4
Fig. 4
Reconstruction of the LIMA (A) and RIMA (B) graft by cCTA
See this image and copyright information in PMC

References

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