Clinical Management
AKARI YAMASHITA, n/a
Resident
Pediatrics, Tokyo, Japan
BACKGROUND/AIM
Giant coronary artery aneurysm is defined as those with a z score of ≥10 or absolute dimension ≥8 mm. In Japanese epidemiological study, giant CAAs are rare with a reported prevalence of 0.02% to 0.38%. Although most giant CAAs are asymptomatic, some KD patients present with angina, myocardial infarction, and sudden death due to thrombotic occlusion or stenosis. The aim of study is to review the mid-term outcomes of KD patients with giant CAAs in our institution.
METHODS
A retrospective study was conducted to review the follow-up data in 8 KD patients (5 males and 3 females) with giant CAAs who were admitted our hospitals from 2005 to 2021.
RESULTS
The median age at diagnosis and current age was 5years (2-14 years) and 20 years (7-30 years), respectively. 5 were diagnosed incomplete KD (62.5%). The median follow-up period was 15.5 years (2-18 years). Seven patients were non-responders to the initial IVIG treatment. All patients received warfarin and anti-platelet drugs such as aspirin during follow-up. Of all, 6 cases had unilateral giant CAAs (1 right, 5 left) and 2 had bilateral giant CAAs. During follow-up, there was no coronary rupture and death. Follow-up coronary angiography showed 3 coronary stenotic lesion including left anterior descending artery without recanalization of CA. Two patients (25%) were underwent coronary artery interventions. One patient with bilateral giant CAAs experienced acute myocardial infarction at 1 year from diagnosis and was performed coronary artery bypass grafting due to recurrent ischemic events. The other patient with multiple CAAs had severe coronary stenosis by follow-up angiography, thus he was given coronary bypass surgery. The remaining 6 patients were asymptomatic, and they had no evidence of cardiac ischemia during follow-up.
CONCLUSION
Most patients with giant CAAs can lead ordinary lives with appropriate management including warfarin treatment.