Reappraisal of Coronary Abnormalities Using Systemic Focused Coronary Echocardiographic Imaging in Kawasaki Disease

Background: Coronary artery abnormalities (CAA) is an important complication in children with Kawasaki disease (KD). The incidence of CAA used to be around 5-10% after acute phase of KD. So far, there had been scanty information about the systemic approach to examine the status of coronary in children with KD. We thus developed a systemic focused coronary echocardiographic imaging (SFCEI) in Kawasaki disease. Methods: Between July 2013 and June 2014, a total of 35 patients with acute phase Kawasaki disease was enrolled in this study. Echocardiography of 100 normal pediatric patients was used for control. In this study, we employed the Siemens ACUSON SC2000 echocardiography system with 8V3 transducer (3-8MHz) for examination. All the patients was examined at diagnosis, 1 week, 2 weeks and repeating at 6-8 weeks after the onset of illness. Assessment of right coronary (proximal and distal portions), left main (middle portion), left anterior descending (proximal and distal portions) and circumflex arteries(proximal portion) was performed in each patients. Coronary abnormality is considered at the presence of any one of the following: 1) dilatation or aneurysm formation 2) lack of tapering 3) irregularity 4) intimal thickening(brightness) Results: Various coronary artery abnormalities were present in Kawasaki disease, include dilatation in 11(31%) patients, aneurysm formation in 2(6%) patients, lack of tapering in 13(37%) patients, irregularity in 12(34%) , and intimal thickening(brightness) in 23(65%) patients. Overall, coronary artery anomalies was present in 32(91%) of our patients in acute phase of disease. Conclusion: Our result showed that the incidence of coronary artery abnormalities in Kawasaki disease is higher than previously reported. Echocardiography can provide an accurate and timely diagnosis regarding the presence of cardiac and coronary artery lesions in Kawasaki diseases. With our SFCEI method, more detailed and comprehensive features of coronary artery abnormalities other than coronary aneurysm and dilatation can be provided.