Lifetime cardiovascular management of patients with previous Kawasaki disease


Lifetime cardiovascular management of patients with previous Kawasaki disease

Brogan P, Burns JC, Cornish J, Diwakar V, Eleftheriou D, Gordon JB, Gray HH, Johnson TW, Levin M, Malik I, MacCarthy P, McCormack R, Miller O, Tulloh RMR; Kawasaki Disease Writing Group, on behalf of the Royal College of Paediatrics and Child Health, and the British Cardiovascular Society.

Heart. 2020 Mar;106(6):411-420. doi: 10.1136/heartjnl-2019-315925. Epub 2019 Dec 16. Review.

PMID: 31843876 Free PMC Article

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Take Home Points

  • Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients..
  • Ptients who develop coronary artery aneuryms (CAA) are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death.
  • Follow-up in a specialized Kawaski disease clinic with experts in Kawaski diseasee and intervnetional cardiology will help better coordinate care.
  • An adult with a past history of KD and CAA, who presents with any symptoms or signs which could be due to aneurysm thrombosis or acute coronary syndrome, should be transferred promptly to a Heart Attack Centre (HAC).
  • Every child or adult followed-up for CAA should have a person-specific protocol (PSP) written, detailing the pathway of care to be followed if a suspected acute coronary syndrome should occur.
  • This consensus statement from the European Royal College of Paediatrics and Child Health, and the British Cardiovascular Society guidance on th llong-term management of patients who have vascula complications of KD and guidance on the emergency management of acute coronary complications.

Dr. Shaji Menon (Salt Lake City, Utah)
Comment from Dr. Shaji Menon (Salt Lake City, Utah), Lead Section Editor of Pediatric Cardiology Journal Watch: Table 1 shows the imaging surveillence protocols for short-term and long-term cornary surveillance and evaluation of myocardial perfusion by level of patient risk. Patients with small or remodelled aneurysms may be seen less frequently, but those with giant aneurysms need regular imaging and assessment to detect developing thrombi within aneurysms, particularly in the early years after the acute KD illness, when the risk of thrombosis is greatest.

Table 2 suggests additional tests to be undertaken during a visit, and in the transition period from paediatric to adult care.