Work

Giant coronary aneurysms in children with Kawasaki disease and major cardiac complications and dynamic follow-up

Year: 2025

Type: article

Abstract: BACKGROUND Giant coronary artery aneurysms (CAA), entailing thrombosis, myocardial infarction, and sudden death, are the most severe and life-threatening complications of Kawasaki disease (KD). Giant aneurysms rarely regress and can later transform into stenoses. Data on dynamic follow-up are scarce in the literature. AIM To evaluate clinical features and long-term outcomes of giant CAA in children with KD. METHODS A single-center retrospective study included data from patients with KD and giant CAA in the Irkutsk region (2012-2023). CAA criteria according to the American Heart Association guidelines of 2017 were used: (1) Dilated coronary artery with diameter Z -score > 2 standard deviations (SD) but < 2.5 SD; (2) Small CAA with Z -score > 2.5 SD but < 5 SD; (3) Medium CAA with Z -score > 5 SD but < 10 SD; and (4) Giant CAA with Z -score > 10 SD or ≥ 8 mm. RESULTS The mean age of children with coronary dilatation/aneurysms was 2.5 years, and the male-to-female ratio was 3:1. Patients with giant/medium CAA had symptoms of cerebral dysfunction more often compared with children with moderate (Z -score < 5 SD but > 2.0 SD) coronary dilatation (62.0% vs 21.0%, P = 0.019). Major cardiovascular events (myocardial infarction, coronary artery bypass grafting, acute coronary syndrome, ischemic cardiomyopathy, left ventricular aneurysm, and giant extracardiac aneurysm) occurred in 55.5% of patients who had giant CAA. At follow-up the complete regression of giant/medium CAA was observed in 58.0% and partial regression in 42.0% after a mean of 2.3 and 5.5 years, respectively. All thrombi detected by echocardiography, CT, and angiography in giant/medium CAA disappeared between 1 year and 5 years (mean: 15 months). All patients survived. CONCLUSION Risk factors for giant CAA were male sex, early age, and cerebral dysfunction. Complete regression of giant coronary aneurysms occurred in 58.0% of patients after follow-up of 2.3 years.

Source: World Journal of Clinical Pediatrics

DOI: 10.5409/wjcp.v14.i4.108920

Authors: Liudmila V Bregel, Olesya S Efremova, Vladimir A Podkamenny, Yurii A Kozlov, Mikhail M Kostik

Institutions: Russian Medical Academy of Continuous Professional Education, Irkutsk Regional Clinical Hospital, Irkutsk State Medical University, Saint Petersburg State Pediatric Medical University

Language: English

Topic: Kawasaki Disease and Coronary Complications

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4416538706