Author + information
- Received June 1, 2015
- Revision received November 24, 2015
- Accepted December 3, 2015
- Published online April 11, 2016.
- John B. Gordon, MDa,∗ (, )
- Lori B. Daniels, MDb,
- Andrew M. Kahn, MDb,
- Susan Jimenez-Fernandez, MDc,
- Matthew Vejar, BSc,
- Fujito Numano, MDc and
- Jane C. Burns, MDc
- aSan Diego Cardiac Center and Sharp Memorial Hospital, San Diego, California
- bDepartment of Medicine, University of California, San Diego, School of Medicine, La Jolla, California
- cDepartment of Pediatrics, Rady Children’s Hospital San Diego and the University of California, San Diego, School of Medicine, La Jolla, California
- ↵∗Reprint requests and correspondence:
Dr. John B. Gordon, San Diego Cardiac Center, 3131 Berger Avenue, San Diego, California 92123.
Objectives The aim of this study was to characterize the range of management issues raised by adults with cardiovascular sequelae from Kawasaki disease (KD) in childhood.
Background Aneurysms resulting from vascular inflammation associated with KD in childhood may remain clinically silent until adulthood. Adults with large aneurysms, unstable angina, or myocardial infarction following KD in childhood present unique challenges to interventional cardiologists and cardiothoracic surgeons.
Methods In an observational study of adults with histories of KD in childhood, data were collected regarding the medical histories and outcomes of 154 adult KD patients, of whom 21 underwent either percutaneous interventions or surgery.
Results Of the 21 subjects with interventions, 11 had been diagnosed with KD in childhood, and 10 had histories of KD-compatible illnesses. Seventeen subjects were asymptomatic until experiencing acute cardiovascular symptoms: acute myocardial infarction (n = 12), angina (n = 2), end-stage congestive heart failure requiring cardiac transplantation (n = 1), and claudication (n = 2).
Conclusions Cardiovascular complications in these subjects illustrate the following points: 1) even small to moderate-sized aneurysms that “normalize” on echocardiography in childhood can lead to stenosis and thrombosis decades after the acute illness; 2) coronary interventions without intravascular ultrasound may result in clinically significant underestimation of vessel luminal diameter; 3) failure to assess the extent of calcification may lead to suboptimal procedural outcomes; and 4) patients with symptomatic peripheral aneurysms may benefit from endarterectomy or resection. Interventional cardiologists should be aware of the potential challenges in treating this growing population of adults.
- coronary artery aneurysm
- pediatric acquired heart disease
- percutaneous coronary intervention
This work supported in part by grants from the Marilyn and Gordon Macklin Foundation to Drs. Burns and Daniels, from the American Heart Association National Affiliate (09SDG2010231) to Dr. Daniels, and from the Clinical Translational Research Institute at the University of California, San Diego (1UL1RR031980-01) and by the REDCap project. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 1, 2015.
- Revision received November 24, 2015.
- Accepted December 3, 2015.
- American College of Cardiology Foundation