Rupture of a giant coronary artery aneurysm due to Kawasaki disease

doi:10.1016/j.athoracsur.2003.06.015

The Annals of Thoracic Surgery

Volume 78, Issue 2, August 2004, Pages 693-695

https://doi.org/10.1016/j.athoracsur.2003.06.015 Get rights and content

Abstract

Coronary artery aneurysm requiring surgery is rare. We report a case of a ruptured giant coronary artery aneurysm due to Kawasaki vasculitis which presented with cardiac arrest and was successfully treated by emergency coronary artery bypass grafting. The controversies surrounding the management of this disease are also discussed.

Section snippets

Comment

Kawasaki disease is a generalized vasculitis of unknown etiology generally found in infancy and early childhood with characteristic clinical features and specific diagnostic criteria (Table 1). The generalized vasculitis also affects the coronary artery resulting in weakness of the arterial wall, which leads to dilatation and aneurysm formation. The incidence is highest in Japan at 100 per 100,000 children in the pediatric age group [2]. The corresponding incidence in Hong Kong is reported to

References (6)

H. Nakano et al.
Repeated quantitative angiograms in coronary arterial aneurysm in Kawasaki Disease
Am J Cardiol
(1985)
H. Kato et al.
Long term consequences of Kawasaki diseasea 10- to 21-year follow-up study of 594 patients
Circulation
(1996)
H. Yanagawa et al.
Results of 12 nationwide epidemiological incidence surveys of Kawasaki disease in Japan
Arch Pediatr Adolesc Med
(1995)

There are more references available in the full text version of this article.

Cited by (20)

Giant left anterior descending artery aneurysm resulting in sudden death
2016, Hellenic Journal of Cardiology
Citation Excerpt :
It has been suggested that chronic overstimulation of the production of nitric oxide, an endothelium-derived relaxation factor, might lead to an imbalance between its beneficial and detrimental effects on coronary dilatation.2 Although CAAs are most commonly atherosclerotic in origin, they may also be congenital6 or secondary to: mucocutaneous lymph node syndrome (Kawasaki disease),7 connective tissue disease, arteritis, mycotic emboli, coronary artery bypass graft surgery or trauma.3,8 Therefore, when available, clinical history and serological tests could facilitate diagnosis.
Coronary artery aneurysm is a rare congenital or vascular inflammation-based anomaly for which the clinical course and optimal timing of treatment remain unclear. Here, we report a case of sudden death caused by a giant coronary artery aneurysm of the left anterior descending artery that presented with chest pain. This case suggests that urgent interventional or surgical repair is needed when a large coronary aneurysm presents with acute ischemic symptoms.
Coronary insufficiency in children: Review of literature and report of a rare case with unknown aetiology
2010, Journal of the Saudi Heart Association
Myocardial ischemia due to coronary artery disease is a rare condition in children. The reported causes of this condition include vasculitis; commonest being Kawasaki’ disease, pre-mature atherosclerosis due to familial dyslipidemias, congenital coronary artery anomalies and post-operative complications of procedures requiring coronary artery re-implantation in children, e.g. arterial switch procedure and Ross procedure. Allograft arteriopathy after heart transplantation is a more recent addition to this list (Mavroudis et al., 1996). Surgical procedures required for the treatment of coronary artery disease in children include, but are not limited to coronary artery re-implantation, re-routing, augmentation of the osteum, and coronary artery bypass grafting (CABG). We present our experience of a rare case of triple vessel coronary artery disease of unknown aetiology in a child, treated with coronary artery bypass grafting procedure.
Clinical and angiographic features of large left main coronary artery aneurysms
2008, International Journal of Cardiology
Citation Excerpt :
Majority of coronary artery aneurysms are atherosclerotic in origin, especially those appearing later in the life [1]. However, they may be congenital [6] or may develop secondary to mucocutaneous lymph node syndrome (Kawasaki disease) [7,8]; connective tissue diseases such as Ehler-Danlos, Marfan [9], ankylosing spondylitis [10]; arteritis such as syphilis, systemic lupus erythematosus, Behçet disease [11–13] and Takayasu arteritis [14–16]; mycotic emboli, trauma, angioplasty, laser procedures, atherectomy, coronary artery bypass graft operation [17], dissection and some rare genetic disorders such as hereditary hemorrhagic telangiectasia [18]. In an autopsy review of 89 cases of coronary artery aneurysm, 52% were atherosclerotic, 17% congenital, 11% mycotic–embolic, 11% dissecting and 4% syphilitic [19].
Coronary artery aneurysms are defined as coronary dilatations which exceed the diameter of normal adjacent segments by 1.5 times. Left main coronary artery (LMCA) is the least frequently involved artery with a prevalence of 0.1%. Majority of coronary artery aneurysms are atherosclerotic in origin. Their size and clinical presentation is variable. A number of complications have been reported to occur during the course of the disease including thrombosis and distal embolization, myocardial ischemia and/or infarction, dissection, vasospasm, calcification, fistulization and very rarely rupture. Large aneurysms of LMCA represent a potentially fatal condition even without concomitant atherosclerotic coronary disease. Because of rarity of coronary artery aneurysms, it is difficult to standardize treatment. In this article, we presented 4 cases of large LMCA aneurysms with various clinical and angiographic features.
Other Important Rashes
2008, Pediatric Emergency Medicine
Other Important Rashes
2007, Pediatric Emergency Medicine
Case Report: Not a Mediastinal Mass! a Ruptured Giant Coronary Aneurysm That Occurred in a Young Man
2022, Frontiers in Surgery

View all citing articles on Scopus

View full text

Case reportRupture of a giant coronary artery aneurysm due to Kawasaki disease

Abstract

Section snippets

Comment

Am J Cardiol

Long term consequences of Kawasaki diseasea 10- to 21-year follow-up study of 594 patients

Circulation

Results of 12 nationwide epidemiological incidence surveys of Kawasaki disease in Japan

Arch Pediatr Adolesc Med

Case report
Rupture of a giant coronary artery aneurysm due to Kawasaki disease