Circulation. 1995;92:3366-3367
(Circulation. 1995;92:3366-3367.)
© 1995 American Heart Association, Inc.
Kawasaki's Disease
Peter C. Frommelt, MD;
Anwer Dhala, MD
From the Division of Pediatric Cardiology, Departments of Pediatrics,
Children's Hospital of Wisconsin, Medical College of Wisconsin
(Milwaukee) (P.C.F.) and the Wisconsin Electrophysiology Group, Department of
Medicine, University of Wisconsin Medical School (Milwaukee) (A.D.).
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Introduction
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 Top
 Introduction
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A previously healthy
6-month-old boy suddenly collapsed at home,
requiring
cardiopulmonary resuscitation. Initial ECG monitoring
by
paramedics showed ventricular fibrillation (Fig 1A
). The
child
was successfully resuscitated and rapidly
stabilized after
cardioversion, with excellent
hemodynamics on arrival at the
pediatric intensive care
unit. Twelve-lead ECG changes were
consistent with an acute
inferior wall myocardial infarction
(Fig 1B
).
Two-dimensional echocardiography documented
normal
intracardiac anatomy with posterior left
ventricular and septal
wall dyskinesis associated with
large (6- to 7-mm-diameter)
aneurysms of the proximal left
anterior descending (LAD) and
left circumflex (LCx) coronary
arteries (Fig 2
) highly suggestive
of Kawasaki's
disease. On review, the parents described a self-limited
febrile
illness associated with rash and conjunctival injection
approximately 6
weeks before the sudden collapse. Creatine kinase
isoenzyme patterns
confirmed myocardial injury, and radionuclide
myocardial perfusion
studies showed perfusion defects in the
inferior and
posterior left ventricle. Selective coronary angiography
showed
large aneurysms in the proximal and distal LAD and proximal
LCx
without obstruction (Fig 3
); an aneurysm in the
proximal
right coronary artery (RCA) was also identified, with
poor antegrade
filling of the distal RCA branches consistent
with severe obstruction/thrombosis
distal to the aneurysm.
Retrograde filling of the distal RCA
was appreciated via collaterals
from the left coronary circulation.
No surgical intervention
was performed; the patient was maintained
on long-term low-dose
aspirin and dipyridamole, with rapid resolution
of the
segmental wall dyskinesis and perfusion defects by follow-up
echocardiography
and radionuclide scans. The LAD
and LCx aneurysms have persisted
by two-dimensional
echocardiographic imaging.
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Figure 1. (top left) Single-lead ECG monitoring during
resuscitation (A) revealed ventricular fibrillation, and
subsequent 12-lead electrocardiography (B) was
consistent with acute inferior wall myocardial
infarction with prominent Q waves and ST elevation in leads III and aVF
and reciprocal changes in leads I, aVL, and the precordial
leads.
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Figure 2. (top right) Two-dimensional
echocardiography from a short-axis window
through the aortic root visualizing the left coronary artery
system. Large (6- to 7-mm-diameter) fusiform aneurysms are
seen in the proximal left anterior descending (LAD) and at the origin
of the left circumflex (CX) coronary arteries. The origins of
the LAD and the left main coronary arteries are of normal size.
The ascending aorta (Ao) and proximal pulmonary artery (PA) are
seen in cross section.
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Figure 3. (bottom right)
Selective left coronary angiography identified large
aneurysms (an) in the proximal and distal left anterior
descendng (LAD) coronary artery (arrows); an aneurysm
can also be seen in the proximal left circumflex (CX) coronary
artery. The distal right coronary artery (RCA) appears to fill
retrogradely from collaterals supplied by the left coronary
circulation.
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Footnotes
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Reprint requests to Peter C. Frommelt, MD, Children's Hospital
of
Wisconsin, 9000 W Wisconsin Ave, PO Box 1997, Milwaukee, WI
53201.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr,
MD, Chief, Department of Pathology, St Lukes 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 Heart
Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
