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(Circulation. 1998;97:410-411.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Kawasaki Disease

Coronary Aneurysms in Mother and Son

Elchanan Bruckheimer, MBBS; Ziad Bulbul, MD; Paul McCarthy, MD; Joseph A. Madri, MD; Alan H. Friedman, MD; ; William E. Hellenbrand, MD

From the Section of Pediatric Cardiology, General Pediatrics (P.M.), and Department of Pathology (J.A.M.), Yale University School of Medicine, New Haven, Conn.

Correspondence to W.E. Hellenbrand, MD, Section of Pediatric Cardiology, Yale University School of Medicine, 333 Cedar St, PO Box 208064, CT 06520-8064.

A 33-year-old woman developed shock and died 16 hours after labor with moderate hemorrhage. Her autopsy revealed (Fig 1) large (>1.5-cm), calcified aneurysms of the proximal right (RCA), left main (LCA), and left anterior descending coronary arteries (Ao indicates aorta). Plain radiographs (Fig 2) demonstrated the calcification. Histology showed no atherosclerotic changes or active arteritis, and the aorta and other large vessels were normal. When the patient was 16 years old, she had had a prolonged undiagnosed febrile illness with peripheral edema and desquamation, lymphadenopathy, and rash. The combination of this previous illness and extensive and solely coronary artery disease suggests Kawasaki disease (KD). This woman's son, the product of that pregnancy, was admitted 5 years later with classic KD. Treatment with high-dose aspirin and single-dose intravenous gamma globulin was initiated on day 5 of illness, with defervescence within 36 hours. Four weeks after discharge, two-dimensional echocardiography showed 4-mm dilatation of the proximal right coronary artery with a long fusiform aneurysm of 5- to 6-mm diameter more distally. The left main coronary artery was dilated to 6 mm, and there was a long fusiform aneurysm of the left anterior descending branch of 6-mm diameter. Fig 3, Parasternal short-axis view showing the aortic valve (Ao) with a dilated left main coronary artery (LCA). Fig 4, Parasternal long-axis view with cranial angulation showing the dilated left main coronary artery and a fusiform aneurysm of the proximal left anterior descending branch (LAD). These findings were present for 6 months . . . [Full Text of this Article]

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