Clinical Images

Rapid Progression of Coronary Aneurysm to Stenosis in a Patient with Kawasaki Disease

Rajesh Sachdeva, MD1 and Brian K. Eble, MD2

Rajesh Sachdeva, MD1 and Brian K. Eble, MD2

Abstract: In Kawasaki disease, coronary aneurysms typically regress slowly, although some may develop stenosis 1-2 decades after the acute illness. This is the first case report describing rapid progression of coronary aneurysm to stenosis within 14 weeks. 

J INVASIVE CARDIOL 2012;24(1):36-37

Key words: coronary artery stenosis, fractional flow reserve, Kawasaki disease

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In Kawasaki disease (KD) coronary aneurysms typically regress slowly, although some may develop stenosis 1-2 decades after the acute illness.1 This is the first case report describing rapid progression of coronary aneurysm to stenosis within 14 weeks.

A 4-year-old boy weighing 19.1 kg was treated for suspected atypical KD with intravenous immunoglobulin and aspirin. In-hospital echocardiogram demonstrated structurally normal coronary arteries and heart function. Echocardiogram 6 weeks later suggested a 5 mm fusiform aneurysm in the left anterior descending artery (LAD) and a 4.3 mm saccular aneurysm in the right coronary artery (Figures 1A and 1B). Cardiac computed tomography angiography (CTA) performed at 14 weeks after the acute illness demonstrated focal LAD stenosis at the aneurysmal site described above (Figure 2). Subsequent coronary angiography revealed a severe stenosis in the proximal LAD-diagonal bifurcation (Figure 3). Fractional flow reserve (FFR) evaluation of LAD was performed with escalating doses of intracoronary adenosine: FFR with 12 µg, 24 µg, 36 µg, and 60 µg of adenosine was 0.73, 0.67, 0.64, and 0.63, respectively (Figure 4); FFR of the diagonal branch at maximum hyperemia was 0.61.

Although FFR has been used to determine coronary ischemia in children with KD,2 our case illustrated the following: (1) the first documented use of adenosine for induction of maximum hyperemia during FFR evaluation in a child; (2) that adult doses of adenosine given intracoronary are well-tolerated in a child; and (3) that rapid progression of coronary aneurysm to stenosis may occur within 14 weeks.

References

  1. Newburger JW, Fulton DR. Coronary revascularization in patients with Kawasaki disease. J Pediatr. 2010;157(1):8-10.
  2. Ogawa S, Ohkubo T, Fukazawa R, et al. Estimation of myocardial hemodynamics before and after intervention in children with Kawasaki disease. J Am Coll Cardiol. 2004;43(4):653-661.

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From the 1Division of Cardiovascular Medicine, Department of Internal Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, Arkansas, and 2the Division of Pediatric Cardiology, Department of Pediatrics, Arkansas Children Hospital and University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Sachdeva reports serving on the speaker’s bureau for Volcano Corporation. Dr. Eble has nothing to report.
Manuscript submitted September 9, 2011, provisional acceptance given September 16, 2011, final version accepted September 29, 2011.
Address for correspondence: Rajesh Sachdeva, MD, Central Arkansas Veterans Healthcare System, 4300 W. 7th Street, Little Rock, AR 72205. Email: rsachdeva@uams.edu and rrsachdeva@gmail.com