Acute Myocardial Infarction Due to Coronary Artery Aneurysm in a Pediatric Patient with Kawasaki Disease

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We report a case of a 4-year-old boy with preceding Kawasaki disease (KD) who presented with acute myocardial infarction (AMI) caused by giant coronary artery aneurysms, a serious complication of KD. Echocardiography at the time of AMI presentation revealed dyskinesis of the apex. He had been on aspirin (85 mg), dipyridamole (50 mg) and warfarin (6.5 mg) orally since the previous KD event. He was transferred to our facility more than 18 hours after the onset of the AMI symptom. Given this delay in transfer and his international normalized ratio of 2.55 on admission, we did not consider percutaneous coronary intervention or thrombolytic therapy was appropriate. Therefore, we simply gave IV heparin infusion. His symptoms improved from that day forward and he was discharged on day 68. At follow-up, ventricular contraction around the apex gradually improved, and enhanced computed tomography showed recanalization of the once occluded vessel. Six months after the AMI diagnosis, the patient underwent coronary artery bypass grafting for better coronary circulation. The postoperative course was uneventful, and cardiac function improved still further.