Pediatric Cardiology University of Benghazi Benghazi, Libya
Background: KD leads to coronary artery aneurysms (CAA) in approximately 25% of untreated cases and 4% of treated ones. The long-term prognosis is determined by the initial and subsequent level of coronary artery involvement (CAI). A review of 12 KD publication from Arab countries identified 6 (50%) series with high prevalence of CAI (Algeria 22.5%, Saudi Arabia 48.2%, Dubai 44.5%, Iraq 44.4%, Oman 24%, and Jordan 41%). The aim of the study was to portray the state of CAA management in the Arab region.
Methods: We conducted an online survey among pediatric cardiologists of the region targeting two major groups of cardiologists practicing in developing countries (Pediatric Cardiology Club: Egypt and Pediatric Cardiology Group: Saudi Arabia). The survey consisted of 5 questions on number of cases with CAA, maximum CAA size followed, imaging modalities and anticlotting strategies used.
Results: From a total of 400 polled physicians, 44 (11%) responded. Of them (Figure 1) 27/44 (61.4%) managed more than 5 cases with CAA, 17/44 (22.7%) managed 2-4, and 7/44 (15.9%) managed 1-2 cases. The largest CAA followed was giant ( >7mm) for 21/44 (47.8%) respondents, while 8/44 (18.2%) followed medium-size CAA (5-7mm), and 15/44 (34.1%) followed small CAA (1-5mm). Echocardiography was the sole imaging modality in 33/44 (77.3%) during the acute stage versus 16/44 (36.4%) in the long-term follow-up (Figure 2). CT-Scan or magnetic resonance was used in addition to echo by 2 and 8 respondents (22.7%) during the acute phase, whereas advanced imaging consisted of CT-scan or magnetic resonance 8/44 (40.9%), invasive angiography 4/44 (9.1%), or all 3 modalities 6/44 (13.6%) for long-term management. Anti-clotting strategies for patients with large CAA ( >7 mm) consisted of (Figure 3) [aspirin + Warfarin] (46.5%) or [aspirin + Heparin] (9.3%), or [aspirin + Warfarin + Other anticoagulant] (16.3%), and only [Warfarin] in 1 case (2%). Ther remaining used dual antiplatelets (18.6%) or aspirin alone (7%).
Conclusions: Majority of respondents are not infrequently exposed to CAA challenges ( >60% attend to ≥5 CAA patients). Modalities of CAA imaging in the acute phase and the follow-up period corroborates with current standards, including a preference for non-invasive coronary artery imaging. Anti-clotting prevention strategies instead, are consistent with recommendations when responders attend for medium or large CAA in general. The present survey did not investigate availability/accessibility to anticoagulants, nevertheless results support quality improvement objectives of the Kawasaki Disease Arab Initiative (KAWARABI) towards awareness and standardization of care.
