Giant Coronary Aneurysm of Kawasaki Disease Developing During Postacute Phase
The patient suffered from Kawasaki disease at 5 months of age. The first angiography, performed 14 months after the onset of disease, showed a right coronary aneurysm with a maximal diameter of 6 mm and normal left coronary artery (Figure 1⇓). Dipyridamole and propranolol were given as antiplatelet therapy and for reduction of myocardial oxygen consumption, respectively. The second angiography, performed 6 years later, revealed enlargement of the right coronary aneurysm, with a maximal diameter of 15 mm (Figure 2⇓). Treatment with dipyridamole and propranolol was continued. Ten years later, when the patient was 17 years old, the chest radiograph showed bulging of the right cardiac border. MRI demonstrated a giant coronary aneurysm (Figure 3⇓). The findings of the ECG did not indicate myocardial ischemia. The third angiography, performed at 18 years of age, showed a giant right coronary aneurysm with a maximal diameter of 86 mm and normal left coronary artery (Figure 4⇓). Because of the imminent risk of rupture, aortocoronary bypass with saphenous vein graft and aneurysmectomy were performed. Pathological studies of the coronary aneurysm showed marked intimal thickening due to fibrocellular proliferation, disappearance of the elastica interna, and thickening of the media (Figure 5⇓).
In general, coronary aneurysms of mild to moderate size (<8.0 mm) resulting from Kawasaki disease regress, probably because of intimal thickening, whereas giant aneurysms progress to become obstructive lesions because of thrombus formation. Enlargement of a coronary aneurysm after the acute phase in Kawasaki disease is an extremely rare phenomenon.
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 A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
- Copyright © 1998 by American Heart Association