Slowly Developed Coronary Artery Aneurysms in a Patient With Probable Kawasaki Disease

A 51-year-old man with de novo exertional angina underwent coronary artery bypass grafting (CABG) with the distal left main trunk (LMT) and proximal right coronary artery (RCA), and resection of a coronary artery aneurysm (CAA) at the distal bifurcation of the LMT (Figure A,B). He had been treated for scarlet fever at 10 years of age and there was no information about whether other principal clinical signs of Kawasaki disease (KD) were present at the time. However, the pathological findings of the resected CAAs, such as destructed thin media, and heavily fibrotic thick intima with severe calcification, were compatible with KD.¹

Figure.

A series of (A–C) volume-rendering and (D) curved multiplanar reconstructed multislice computed tomography images (row 1: preoperative, row 2: 3 months after surgery, row 3: 6 years after surgery, row 4: 10 years after surgery). A giant coronary artery aneurysm (CAA) of 19×16×17 mm in diameter at the distal bifurcation of the left main trunk, and recanalization after right coronary artery (RCA) occlusion is shown in A–C. The slowly progressing CAA in the distal RCA is indicated by the yellow arrows.

There were no general symptoms or organ dysfunction related to immunological disorders, including autoimmune diseases, after becoming an adult. More than 10 years after CABG, serum levels of high-sensitivity C-reactive protein, anti-nuclear antibodies, IgG4, and blood complement were normal. However, a series of coronary multislice computed tomography (MSCT) images showed slowly progressing de novo CAAs in the distal RCA (Figure, yellow arrows).

These 2-staged CAAs showed the persistent coronary arterial structural dysfunction of a middle-aged patient with probable KD who did not receive initial immunological suppressive treatments in childhood. Therefore, coronary artery remodeling due to vasculitis will persist, necessitating very long-term clinical follow-up of adult patients with previous KD.

Acknowledgment

This work was supported by JSPS KAKENHI Grant no. JP18H02806 to T.I.

Disclosures

I.T. is a member of Circulation Journal’ Editorial Team.

Reference

• 1.   JCS/JSCS 2020 guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease. Tokyo: Japanese Circulation Journal (in Japanese).