Coronary Aneurysms in Mother and Son
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 and then resolved completely. Coronary artery aneurysms due to KD occurring in a parent and child have not been reported previously.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC1-267, Houston, TX 77030.
- Copyright © 1998 by American Heart Association