Acute Myocardial Infarction with Multiple Giant Coronary Artery Aneurysms in a Juvenile with Kawasaki Disease

Abstract

Coronary artery aneurysm (CAA), the most risky late complication of Kawasaki disease (KD), is associated with severe adverse cardiac events, such as acute myocardial infarction (AMI), in young patients. Herein, we describe a 16-year-old boy who suffered from occasional angina attack after a recent myocardial infarction due to multiple giant CAAs during the asymptomatic period of KD. Coronary angiography (CAG) revealed multiple large CAAs of about 9 mm in diameter at the left anterior descending artery (LAD) and more than 12 mm at the left circumflex coronary artery (LCX). To optimize the management and reduce the morbidity and mortality of giant CAAs, it is imperative to consider antecedent KD at the earliest possible stage, particularly in young patients with angina pectoris or AMI but lacking traditional risk factors for atherosclerosis. Long-term follow-up with an electrocardiogram (ECG), echocardiogram, or coronary computed tomography angiography (CCTA) is essential and should not be overlooked. In addition, this case highlights the great significance of working out a more comprehensive and effective management strategy for such KD juveniles, including drugs, percutaneous coronary intervention (PCI) or even surgery.

Keywords

Coronary ectasia / Mucocutaneous lymph node syndrome / Acute coronary syndrome / Adolescent

Author Contributions

Conceptualization, C.C., L.Q., W.C. and C.Z.; Investigation, C.C. and C.Z.; Resources, W.C. and C.Z.; Writing-Original Draft Preparation, C.C.; Writing-Review & Editing, C.Z. and L.Q.; Visualization, C.C. and C.Z.; Supervision, L.Q. and W.C.; Project Administration, C.Z.

Ethics Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Qilu Hospital of Shandong University (KYLL-202407-054-1, July 2024).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Funding

This research received no external funding.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

[1] Newburger JW, Takahashi M, Burns JC. Kawasaki Disease. J. Am. Coll. Cardiol. 2016, 67, 1738-1749.

[2] Kawsara A, Núñez Gil IJ, Alqahtani F, Moreland J, Rihal CS, Alkhouli M. Management of Coronary Artery Aneurysms. JACC Cardiovasc. Interv. 2018, 11, 1211-1223.

[3] Alioglu E, Turk UO, Engin C, Tengiz I, Tuzun N, Posacioglu H. Left main coronary artery aneurysm in young patient with acute myocardial infarction. J. Cardiovasc. Med. 2009, 10, 494-496.

[4] McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association. Circulation 2017, 135, e927-e999.

[5] Bayers S, Shulman ST, Paller AS.Kawasaki disease: Part II. Complications and treatment. J. Am. Acad. Dermatol. 2013, 69, 513.e1-513.e8.

[6] Yeu BK, Menahem S, Goldstein J. Giant coronary artery aneurysms in Kawasaki disease—The need for coronary artery bypass. Heart Lung Circ. 2008, 17, 404-406.

[7] Gulati R, Behfar A, Narula J, Kanwar A, Lerman A, Cooper L, et al. Acute Myocardial Infarction in Young Individuals. Mayo Clin. Proc. 2020, 95, 136-156.

[8] Bhagwat A, Mukhedkar S, Ekbote S, Gordon JB. Missed Kawasaki disease in childhood presenting as myocardial infarction in adults. Indian. Heart J. 2015, 67, 385-388.

[9] Elakabawi K, Lin J, Jiao F, Guo N, Yuan Z. Kawasaki Disease: Global Burden and Genetic Background. Cardiol. Res. 2020, 11, 9-14.

[10] Soni PR, Noval Rivas M, Arditi M. A Comprehensive Update on Kawasaki Disease Vasculitis and Myocarditis. Curr. Rheumatol. Rep. 2020, 22, 6.

[11] Kwak JH, Ha EK, Kim JH, Cha HR, Lee SW, Han MY. Association of Familial History of Diabetes, Hypertension, Dyslipidemia, Stroke, or Myocardial Infarction with Risk of Kawasaki Disease. J. Am. Heart Assoc. 2022, 11, e023840.

[12] Kuo HC. Preventing coronary artery lesions in Kawasaki disease. Biomed. J. 2017, 40, 141-146.

[13] Brogan PA, Bose A, Burgner D, Shingadia D, Tulloh R, Michie C, et al. Kawasaki disease: An evidence based approach to diagnosis, treatment, and proposals for future research. Arch. Dis. Child. 2002, 86, 286-290.

[14] Gray H, Cornish J. Kawasaki disease: A need for earlier diagnosis and treatment. Arch. Dis. Child. 2019, 104, 615-616.

[15] Pham V, Hemptinne Q, Grinda JM, Duboc D, Varenne O, Picard F. Giant coronary aneurysms, from diagnosis to treatment: A literature review. Arch. Cardiovasc. Dis. 2020, 113, 59-69.

[16] Fukazawa R, Kobayashi J, Ayusawa M, Hamada H, Miura M, Mitani Y, et al. JCS/JSCS 2020 Guideline on Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease. Circ. J. 2020, 84, 1348-1407.

[17] Takahashi M, Mason W, Lewis AB. Regression of coronary aneurysms in patients with Kawasaki syndrome. Circulation 1987, 75, 387-394.

[18] McCrindle BW, Manlhiot C, Newburger JW, Harahsheh AS, Giglia TM, Dallaire F, et al. Medium-Term Complications Associated with Coronary Artery Aneurysms After Kawasaki Disease: A Study from the International Kawasaki Disease Registry. J. Am. Heart Assoc. 2020, 9, e016440.

[19] Imai Y, Sunagawa K, Ayusawa M, Miyashita M, Abe O, Suzuki JI, et al. A fatal case of ruptured giant coronary artery aneurysm. Eur. J. Pediatr. 2006, 165, 130-133.

[20] Mavrogeni S. Coronary artery ectasia: From diagnosis to treatment. Hellenic J. Cardiol. 2010, 51, 158-163.

[21] Lee J, Kim GB, Kwon BS, Bae EJ, Noh CI.Two cases of super-giant coronary aneurysms after kawasaki disease. Korean Circ. J. 2014, 44, 54-58.

[22] Ono R, Umehara N. Multiple Giant Coronary Artery Aneurysms in Kawasaki Disease. Mayo Clin. Proc. 2021, 96, 1888-1889.

[23] Suda K, Kudo Y, Higaki T, Nomura Y, Miura M, Matsumura M, et al. Multicenter and retrospective case study of warfarin and aspirin combination therapy in patients with giant coronary aneurysms caused by Kawasaki disease. Circ. J. 2009, 73, 1319-1323.

[24] Marek-Iannucci S, Junarta J, Vishnevsky A, Rajapreyar IN, Fradin JJ, Arditi M, et al. Severe late cardiovascular sequelae of Kawasaki disease in a young adult. J. Paediatr. Child. Health. 2024, 60, 147-150.

[25] Abugroun A, Vilchez D, Hallak O, Shahrrava A. A History of Kawasaki Disease from Childhood and Coronary Artery Ectasia with Recurrent ST Elevation Myocardial Infarction: A Therapeutic Challenge. Cardiol. Res. 2017, 8, 344-348.

[26] Kaneko U, Kashima Y, Hashimoto M, Fujita T. Very Late Stent Migration within a Giant Coronary Aneurysm in a Patient with Kawasaki Disease: Assessment with Multidetector Computed Tomography. JACC Cardiovasc. Interv. 2017, 10, 1799-1800.

[27] Tsuda E. Coronary artery bypass grafting for coronary artery stenosis caused by Kawasaki disease. Expert. Rev. Cardiovasc. Ther. 2009, 7, 533-539.