Pediatrics & Therapeutics
Open Access
ISSN: 2161-0665
+44 1478 350008
ISSN: 2161-0665
+44 1478 350008
Jo Won Jung
Yonsei University College of Medicine, Republic of Korea
Posters & Accepted Abstracts: Pediatr Ther
Kawasaki disease (KD) is an acute febrile disease of unknown etiology. It causes systemic inflammation of vessels through the whole body and especially affects coronary arteries in children younger than 5 years of age. The disease leads to coronary artery aneurysms in �??25% of untreated cases. However, approximately 20% of patients who require a second dose of IVIG for KD do not adequately respond to this treatment and require additional medications such as corticosteroid or infliximab. KD was first identified in Japan by Tomisaku Kawasaki in 1967, and has now been described worldwide. In Korea, the annual incidence of KD was 194.7 per 100,000 children in 2014, and the coronary aneurysm rate was 1.7%. The natural history of coronary arterial inflammation in KD was demonstrated to occur through 3 mechanisms as reported previous studies: (1) No coronary artery changes, (2) Mild, transient dilatation that resolves within 4-6 weeks, (3) Necrotizing arteritis that forms an aneurysm. Such risk assessment depends on the patient�??s maximal Z score in any branch by echocardiography or coronary angiography/angio-computed tomography. Stress myocardial scintigraphy has been shown to be useful for risk stratification, but we should consider its radiologic hazard. Korean nationwide data collected between 1990 and 2011 reported, and showed 239 patients with coronary aneurysms of diameter >6 mm. Severe stenosis or occlusion of the coronary artery were analyzed, and percutaneous transluminal coronary balloon angioplasty was performed in 10 patients, stent placement in 9 patients, and percutaneous transluminal coronary rotational ablation in 3 patients. Thirteen patients presented with suggestive myocardial infarction, 14 patients underwent coronary artery bypass graft surgery, and 5 patients died during the follow-up period. For KD patients with giant coronary aneurysm, careful planning of follow-up is mandatory for long-term manage, and aggressive treatments with transcatheter or surgical intervention are needed.