Disparate results for human coronavirus as causative agent likely correspond to the concept that the inflammations associated with Kawasaki disease does not result from a single infectious trigger but rather a final common inflammatory pathway, in susceptible individuals, following a variety of infectious or environmental triggers. It is hoped that there will be a change in the current diagnostic criteria, which do not apply in cases of incomplete disease. So detailed algorithm and new diagnostic criteria may be needed. In patients whose Kawasaki disease is resistant or refractory to IVIG, treatment with tumor necrosis factor (TNF-alpha) blockade and steroids seems to be safe and promising deserving of future study. Echocardiography is important in confirming the diagnosis and should be performed in all suspected cases. New non-invasive tools including MRA and MSCT are of great value for the follow-up of aneurysm progress and outcome.
Aneurysm ; Coronavirus ; Diagnosis ; Echocardiography ; Follow-Up Studies ; Hope ; Humans ; Immunoglobulins, Intravenous ; Inflammation ; Mucocutaneous Lymph Node Syndrome* ; Steroids ; Tumor Necrosis Factor-alpha ; Infliximab

Kawasaki disease is characterized by a variety of symptoms and signs resulted from systemic vasculitis. Although the etiology of the disease remains uncertain, its serious coronary sequelae have been proved to cause ischemic heart disease in children. Coronary artery aneurysms or ectasia develop in approximately 20% of untreated children with the disease and may lead to coronary ischemia. Although the incidence of severe coronary arterial stenosis is low (2-3%), but once myocardial infarction occurs in children, the mortality is quite high (22% at the first infarction). Children with coronary aneurysms should be assessed carefully with periodic stress testing for reversible ischemia. Coronary artery bypass surgery is indicated when there is an evidence of myocardial ischemia even in small children. However, one should keep in mind that the ability to recanalize or develop collateral vessels in children is very high and recanalization is frequently noted in the right coronary artery. Internal thoracic arteries are the graft of choice. We performed coronary bypass grafting in 5 patients with Kawasaki disease since 2001. The mean age of the patients was 18.8+/-11.2 (range, 2-30) year. The mean number of anastomosis was 1.8+/-1.1. All patients survived and have revealed no evidence of myocardial ischemia during follow-up.
Aneurysm ; Child ; Constriction, Pathologic ; Coronary Aneurysm ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Dilatation, Pathologic ; Exercise Test ; Follow-Up Studies ; Humans ; Incidence ; Ischemia ; Mammary Arteries ; Mortality ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction ; Myocardial Ischemia ; Systemic Vasculitis ; Transplants

The incidence of coronary artery disease requiring coronary intervention in patients with Kawasaki disease is high. Because coronary artery lesions in Kawasaki disease commonly involve severe calcification and aneurysmal changes which can progress with time, in contrast with adult atherosclerotic coronary artery lesions, the indication or technique of catheter intervention for adult patients cannot be directly applied. However, the experience of coronary intervention in Kawasaki disease is extremely limited compared to that with intervention in adults, which provides satisfactory therapeutic results. There are several kinds of percutaneous coronary intervention techniques in Kawasaki disease including balloon angioplasty, stent implantation, rotational ablation, and directional coronary atherectomy. Satisfactory acute results for coronary balloon angioplasty can be obtained in patients in a relatively short interval from the onset of disease, especially within 6 years. However, the incidence of restenosis after angioplasty is still high. Stent implantation acquires larger luminal area, less restenosis rate and less aneurysmal formation than balloon angioplasty. Rotational ablation is a good interventional option with high success rate for longstanding Kawasaki disease with severe calcification. Intravascular ultrasound imaging provides valuable information for the selection of the appropriate interventional procedure and the assessment of postprocedural outcomes. To obtain good result and optimal decision making, cooperation between pediatric and adult cardiologists is essential. Postprocedural anticoagulation or antiplatelet regimens are required for proper long-term management.
Adult ; Aneurysm ; Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary ; Atherectomy, Coronary ; Catheters ; Coronary Artery Disease ; Coronary Vessels ; Decision Making ; Humans ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Percutaneous Coronary Intervention ; Phenobarbital ; Stents ; Ultrasonography

With advancements of high frequency transducer, transthoracic Doppler echocardiography (TTE) is emerging as a promising method for evaluating coronary artery. In addition to visualizing the images for detection of stenosis of proximal and distal coronary artery and various kinds of coronary artery anomaly, functional assessment through measurement of coronary flow reserve using TTE have become a valuable and additive tool for coronary angiography defining only the epicardial coronary arteries. Further efforts for development of new techniques including real time 3D echocardiography in the anatomic and functional assessment of coronary artery disease should be undertaken.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Circulation ; Coronary Vessels* ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Three-Dimensional ; Transducers

Kawasaki disease (KD) is an acute, self-limiting, small-vessel vasculitis with an unknown cause that affects children between the ages of 6 months and 5 years. It is the most common cause of acquired coronary artery disease in childhood. Acute myocardial infarction and coronary artery aneurysm are major complications. Although an infectious agent is highly suspected, the etiology of KD is unknown. Significant progress has been, however, toward understanding the natural history of this disease, and therapeutic interventions have been developed that halt the immune-mediated destruction of the vascular system. The pathology of the necrotizing vaculitis of KD suggests a primary role for monocytes-macrophages and T lymphocytes in the acute vascular injury observed. KD fits nicely in the spectrum between an infectious disease and a true autoimmune disease, with an infectious trigger leading to a prolonged self-directed immune response. This review focuses on recent data concerning the immunopathogenesis of vascular damage, and the involvement of CD4+CD25+ regulatory T cells (Treg) in KD.
Aneurysm ; Autoimmune Diseases ; Child ; Communicable Diseases ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction ; Natural History ; Pathology ; T-Lymphocytes ; T-Lymphocytes, Regulatory ; Vascular System Injuries ; Vasculitis

Kawasaki disease (KD) is an acute multisystem vasculitic syndrome of unknown etiology occurring mostly in infants and children younger than 5 years of age. In developed countries, KD is currently the leading cause of acquired heart diseases in children. The incidence of KD is increasing globally. The first generation of patients with KD has now reached reproductive age, and the incidence of 2-generation cases may thus increase in number. Many gene polymorphisms are associated with KD in different populations. There are many individual and racial gene variation. Susceptible gene should be identified in the KD. Individuals with certain genes predisposing to occurrence and severity of KD could be detected in different ethnic populations. This might allow special treatment or other measures to prevent the disease and possibly limit the severity and complications of KD. I reviewed and summarized Korean and international articles about gene studies. Multicenter gene studies are needed to investigate the association between specific genes and coronary artery lesions in KD.
Child ; Coronary Vessels ; Developed Countries ; Heart Diseases ; Humans ; Incidence ; Infant ; Mucocutaneous Lymph Node Syndrome*

Evidence-based medicine is a medical movement combining professional experience with the best scientific research results. Treatment of Kawasaki disease in the acute phase is directed at reducing inflammation in the coronary artery wall and preventing coronary thrombosis, whereas long-term therapy in individuals who develop coronary aneurysms is aimed at preventing myocardial ischemia or infarction. I attempt to summarize the current state of knowledge of the medical management of patients with Kawasaki disease. The recommendations are evidence-based and derived from published data wherever possible.
Coronary Aneurysm ; Coronary Thrombosis ; Coronary Vessels ; Evidence-Based Medicine ; Humans ; Infarction ; Inflammation ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Ischemia

Kawasaki disease (KD) is an acute systemic febrile illness, predominantly affecting children less than the age of 5 years. After its first description in 1967 by Dr Tomisaku Kawasaki, KD has become the leading cause of acquired heart diseases in children in developed nations. KD has been reported in all racial and ethnic groups but the incidence of KD is more common among Asians, and the incidence of the disease varies considerably among different Asian countries. There is a higher rate of KD reported in Asian countries such as Japan and Korea than in other countries. which suggests differences of race-specific susceptibility. In Korea, from 1990s, a nationwide epidemiologic study has been conducted every 3 years by the Korean Pediatric Heart Association to determine the epidemiologic patterns and incidence rate of KD in Korea. So the average annual incidence, 105.0/100,000 children < 5 years in recent study (2003-2005) was the second highest reported rate in the world after Japan.
Asian Continental Ancestry Group ; Child ; Developed Countries ; Epidemiologic Studies ; Epidemiology ; Ethnic Groups ; Heart ; Heart Diseases ; Humans ; Incidence ; Japan ; Korea* ; Mucocutaneous Lymph Node Syndrome* ; Prevalence

No abstract available.
Critical Pathways* ; Heart* ; Postoperative Care* ; Thoracic Surgery*

No abstract available.
Heart Defects, Congenital*