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Abstract
Purpose:
To evaluate the coronary angiographic findings of patients with Kawasaki disease and to investigate the natural course of aneurysms of the coronary artery.
Materials and Methods:
Between June 1989 and January 1996, we evaluated the coronary angiographic findings of 12 consecutive children with Kawasaki disease whose coronary artery was abnormal. On initial study, we retrospectively analysed the size, configuration, and location of 35 coronary aneurysms, and in five children, follow-up coronary angiography was performed at intervals of 17 to 28 (mean, 23) months. Seventeen aneurysms detected on initial study were evaluated for subsequent change.
Results:
Initial coronary angiography showed the aneurysms to be diffuse in 7 cases(20%), saccular in 7(20%), fusiform in 17(49%), and tubular in 4(11%). They were large in 10 cases (29%), medium in 22(63%), and small in 3(9%); their location in the coronary artery was proximal(71 %), middle in 6(17%), and distal in 4(11%). The right coronary artery was involved in 18 case(51 %), and the left coronary artery in 17(49%). Follow-up study showed that the aneurysm had regressed in 11 cases (65%), persisted in 2(12%), and progressed to stenosis in 1(6%) and occlusion in 3(18%). Two(50%) of the four large aneurysms showed complete occlusion. On the other hand, medium and small aneurysms showed regression in 9(82%) and in all cases, respectively. Diffuse-type aneurysms were complicated by occlusion in 2 cases (50%) and stenosis in 1(25%)· On the other hand, six fusiform aneurysms (75%) and all saccular and tubular aneurysms had regressed.
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Fig. 1.
Four shapes of coronary arterial aneurysms in Kawasaki disease A. Angiogram of the right coronary artery demonstrates a large diffuse aneurysm involving the entire right coronary artery. B. Angiogram of the right coronary artery reveals three saccular aneurysms in the right coronary artery. C. Angiogram of the left coronary artery reveals two fusiform aneurysms in the proximal portions of left anterior descending artery and left circumflex artery. D. Angiogram of the left coronary artery reveals a tubular aneurysm in the proximal portion of left circumflex artery (arrow).
Fig. 2.
Serial angiograms showing the complete regression of coronary aneurysm. On initial angiogram of a 5-year-old boy, two fusiform aneurysms are seen in the proximal and middle portion of right coronary artery(A). Follow-up angiogram 15 months later shows apparently normal right coronary artery, suggesting regression of the coronary aneurysms (B).
Fig. 3.
Serial angiograms showing the total occlusion of coronary aneurysm. On initial angiogram of a 4-year-old girl, two large diffuse aneurysms are seen in the right coronary artery (A). Follow-up angiograms 9 months later show a total occlusion of the proximal portion of right coronary artery (B) and a collateral circulation from the left coronary artery to the distal portion of right coronary artery(C).
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