Because most significant complication of Kawasaki disease (KD) is coronary aneurysms, echocardiography is an indispensable part of clinical practice and quality control of echocardiography is mandatory. On the other hand, Japanese government has enforced a law of regular school cardiac screening (SCS) at 1st, 7th, and 10th grader in 1995 and all patients with a history of KD were screened for coronary artery lesion. In this study we report 2 patients with coronary aneurysms picked up by SCS.
Case1: A 6-year-old boy was diagnosed with KD at 3 year old and received immunoglobulin (2g/kg/day). His condition improved within 8 days of illness and echocardiographic finding of coronary artery was “normal” in acute phase and at 1and 3 months after the onset of KD. Since then he did not visit clinic for follow-up. At 1st grader SCS, he was diagnosed as having giant coronary artery aneurysms by echocardiography. Indeed coronary angiography revealed sequential coronary aneurysms of 10.8 mm and 12.3 mm in diameter at segment 6 and 5 with a 99% stenosis in between them. Because of signs of coronary ischemia on myocardial perfusion scan, he underwent percutaneous coronary interventions and coronary artery bypass graft surgery later.
Case2: A 9-year-old boy was diagnosed with juvenile idiopathic arthritis and his fever continued 10 days. He underwent echocardiography at 9 days of illness but coronary artery lesions were not found. At 7th grader SCS, he was diagnosed as having coronary artery aneurysms by echocardiography. Coronary angiography revealed coronary artery aneurysms of 6.1mm and 6.1 mm in diameter at segment 1 and segment 6. Since then he has been placed on oral aspirin.
These 2 cases highlight the issue concerning timing and quality of echocardiography and importance of SCS in detecting patients with coronary undiagnosed aneurysms.