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Brogan et al recommended life long follow up for patients with Kawasaki disease, including those who did not have coronary artery involvement. The reason they quoted was to document the blood pressure and provide general advice regarding other risk factors.1 The American Heart Association recommends echocardiographic (ECG) evaluation of the coronary arteries at presentation and follow up ECG at 6–8 weeks and 6–12 months after the onset of symptoms for those who did not have or just have transient coronary artery involvement. They do not recommend follow up after first year unless cardiac disease is suspected.2
Tuohy et al demonstrated, in their multi-institutional review of 536 patients, that no patient with a normal follow up ECG, performed within 2 months following disease onset, subsequently developed echocardographic coronary artery abnormalities. Even those patients with initial echocardiographic abnormalities that became normal at 1–2 months remained normal thereafter.3 Scott and colleagues showed that no patient with a normal ECG at 2 weeks to 2 months after the onset of symptoms had subsequent ECGs that revealed coronary artery abnormalities and questioned the value of 6–12 month ECG in the same group.4
Brogan et al did not make any comments about the adverse effects of life long follow up, such as anxiety and inappropriate restriction of activities. Finally, there were no comments about the cost and resources for providing life long follow up. The authors did not specify whether paediatric cardiologists, general paediatricians, or general practitioners would follow up; all of them already have increasing demands of workload.
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