Yonsei Med J.  2014 Mar;55(2):353-359.

Changes in Coronary Perfusion after Occlusion of Coronary Arteries in Kawasaki Disease

• Kwak JH
• Song J
• Kang IS
• Huh J
• Lee HJ

Abstract

PURPOSE
Myocardial infarction in children with total occlusion of a coronary artery after Kawasaki disease is rare due to multiple collateral vessels. We aimed to investigate the changes in coronary perfusion associated with coronary artery occlusion after Kawasaki disease.
MATERIALS AND METHODS
Eleven patients with coronary artery occlusion after Kawasaki disease were investigated. Serial coronary angiographies after total occlusion of a coronary artery were reviewed and the changes were described in all patients with additive information collected.
RESULTS
The median age at the occlusion was 5.9 years old. The interval to occlusion was 6.2+/-6.9 years. Four left anterior descending coronary artery total occlusions and 10 right coronary artery total occlusions were detected. Immediate coronary artery bypass graft for left anterior descending coronary artery total occlusion made right coronary total occlusion occurred in all except one patient and the intervals thereof were 1 year, 1.8 years, and 4 years. Collaterals to the left coronary artery regressed after recanalization, while new collaterals to the right coronary artery developed. In three, collaterals to the right coronary artery decreased without recanalization without clinical signs.
CONCLUSION
The right coronary artery should be followed up carefully because of possible occlusion of new onset or changes in collaterals.

Keyword

Kawasaki disease; coronary occlusion; coronary collaterals; coronary angiography

MeSH Terms

Child
Coronary Angiography
Coronary Artery Bypass
Coronary Occlusion
Coronary Vessels*
Humans
Methods
Mucocutaneous Lymph Node Syndrome*
Myocardial Infarction
Perfusion*
Transplants

Figure

• 

  Fig. 1 (Patient 4) Kawasaki disease was diagnosed at the age of 5 years and his first coronary angiography at the age of 5.9 years showed total occlusion of the LAD (A). RCA angiogram showed aneurysm and collaterals to the LAD (B). The next coronary angiography was performed 6 months after coronary artery bypass graft to the LAD and showed RCA total occlusion (C), collaterals from left circumflex coronary artery (arrow) (D), and CABG flow to left anterior descending coronary artery (arrow) (E). LAD, left anterior descending coronary artery; RCA, right coronary artery; CABG, coronary artery bypass graft.

• 

  Fig. 2 (Patient 10) Kawasaki disease was diagnosed at the age of 3 months. His first coronary angiography was performed at the age of 1.5 years and showed right coronary artery total occlusion (A) with collaterals from left coronary artery (arrow) (B). Coronary angiography performed 1 year later demonstrated decrease in collaterals to the right coronary artery from the left coronary artery (C).

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