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Abstracts and presentations are embargoed for release at date and time of presentation or time of AHA/ASA news event. Failure to honor embargo policies (http://newsroom.heart.org/newsmedia/embargo-policy) will result in the abstract being withdrawn and barred from presentation.
Poster Abstract PresentationsSession Title: Poster Session 2

Abstract 223: Surgical Resolution of Coronary Artery Obstruction in Incomplete Kawasaki Disease

Andres N Rodriguez, Maria Del Rocio Maldonado, Enrique Faugier, Javier E Tomala, Angel D Flores, Diego Salinas, Fernando Garcia, Paola B Lara
Circulation. 2015;131:A223
Andres N Rodriguez
Hosp Infantil de Mexico Federico Gomez, Mexico city, Mexico
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Maria Del Rocio Maldonado
Hosp Infantil de Mexico Federico Gomez, Mexico city, Mexico
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Enrique Faugier
Hosp Infantil de Mexico Federico Gomez, Mexico city, Mexico
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Javier E Tomala
Hosp Infantil de Mexico Federico Gomez, Mexico city, Mexico
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Angel D Flores
Hosp Infantil de Mexico Federico Gomez, Mexico city, Mexico
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Diego Salinas
Hosp Infantil de Mexico Federico Gomez, Mexico city, Mexico
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Fernando Garcia
Hosp Infantil de Mexico Federico Gomez, Mexico city, Mexico
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Paola B Lara
Hosp Infantil de Mexico Federico Gomez, Mexico city, Mexico
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Abstract

Case Report 8 months old male, who presented with 7 days fever, hematuria, conjunctival injection and limb edema; treated as a post infectious glomerulonephritis. Twenty days later, desquamation at the tip of the fingers and in palms and soles plus thrombocytosis were found. Considering Kawasaki disease (KD), an echocardiogram was performed, finding a 5mm aneurysm in right coronary artery and 4mm ectasia in the left coronary artery. The patient was on the subacute therefore IVIG was not administered; aspirin however in antiplatelet dose range was begun. He continued on surveillance by Cardiology Department without signs of cardiac malfunction. At two years follow up a new echocardiogram was performed, showing a left coronary aneurism of 6mm and a right coronary artery of 2.0mm which was difficult to identify. Left ventricular function was preserved with an ejection fraction of 72%. Four years later, posterior myocardial necrosis, without acute ischemia on electrocardiography was found. A perfusion myocardial scan showed an uptake defect in apical region, both during stress and rest phase, suggesting an old apical infarction. Cardiac catheterization reported a tortuous right coronary artery with diffuse obstruction and left coronary artery aneurysm of 6.1mm. Due to findings above, heart transplant was considered. On a second perfusion scan a large perfusion defect on the inferior and septal wall, which improved during the rest phase was seen. The finding above correlates with inferior and septal myocardial infarction and residual ischemia. The PET-CT scan showed viable tissue in the left ventricle wall. Recently, the patient underwent revascularization surgery of right coronary artery with coronary artery bypass graft. Postsurgical echocardiogram reported a left coronary giant aneurysm of 8mm, ejection fraction of 40%, and a compromised posterior and inferior left ventricular wall function. We report the first case of surgical resolution of a coronary artery obstruction due to KD in our medical center. Because of patient’s age and coronary arteries abnormalities, a surgically intervention was the best approach in order to preserve patient’s life, cardiac function, improve the prognosis and mainly to gain time for future treatment decisions.

  • Coronary artery bypass grafting (CABG)
  • Kawasaki disease
  • Aneurysms
  • Author Disclosures: A.N. Rodriguez: None. M. Maldonado: None. E. Faugier: None. J.E. Tomala: None. A.D. Flores: None. D. Salinas: None. F. Garcia: None. P.B. Lara: None.

  • © 2015 by American Heart Association, Inc.
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April 28, 2015, Volume 131, Issue Suppl 2
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    Abstract 223: Surgical Resolution of Coronary Artery Obstruction in Incomplete Kawasaki Disease
    Andres N Rodriguez, Maria Del Rocio Maldonado, Enrique Faugier, Javier E Tomala, Angel D Flores, Diego Salinas, Fernando Garcia and Paola B Lara
    Circulation. 2015;131:A223, originally published June 29, 2015

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    Abstract 223: Surgical Resolution of Coronary Artery Obstruction in Incomplete Kawasaki Disease
    Andres N Rodriguez, Maria Del Rocio Maldonado, Enrique Faugier, Javier E Tomala, Angel D Flores, Diego Salinas, Fernando Garcia and Paola B Lara
    Circulation. 2015;131:A223, originally published June 29, 2015
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