Question

Diagnosis and management of a child with Kawasaki disease having:
Coronary artery aneurysm in Kawasaki disease.

Hint:

Early diagnosis and treatment of Kawasaki disease are crucial in preventing coronary artery aneurysms and associated complications.

Answer 1

Coronary artery aneurysms (CAA) are a major complication of Kawasaki disease (KD) and represent the most serious risk for cardiovascular morbidity and mortality in affected children.
Step 1: Pathophysiology:
1. Vascular Inflammation: In Kawasaki disease, inflammation of the arterial walls leads to weakening of the vessel walls, making them prone to dilatation and aneurysm formation.
2. Coronary Artery Involvement: The coronary arteries are most commonly affected, leading to dilation, thrombosis, or rupture.
3. Risk Factors: Factors such as delayed treatment with IVIG, age under one year, and male gender increase the risk of developing coronary artery aneurysms.
Step 2: Diagnosis:
1. Echocardiography: The primary diagnostic tool to evaluate coronary artery dilation and aneurysm formation. Repeat imaging may be required to monitor changes.
2. Coronary Angiography: In cases of severe aneurysms or uncertain findings, coronary angiography can provide detailed information about the extent of coronary involvement.
Step 3: Management and Prognosis:
1. IVIG Therapy: Early treatment with IVIG helps reduce the incidence of coronary artery aneurysms.
2. Aspirin: Low-dose aspirin is used for antiplatelet therapy to prevent thrombosis in affected arteries.
3. Surgical Intervention: In severe cases, coronary artery bypass grafting or stenting may be needed to manage large aneurysms and prevent rupture.
Step 4: Long-Term Follow-Up:
Children with coronary artery aneurysms need long-term follow-up to monitor for potential complications such as myocardial infarction or sudden death.