CARDIOVASCULAR INVOLVEMENT IN KAWASAKI’S SYNDROM1

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CARDIOVASCULAR INVOLVEMENTIN KAWASAKIS SYNDROM


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Kawasaki disease (KD) is an acute febrile vasculiticsyndrome of early childhood, who presented withfever, rash, conjunctival injection, cervicallymphadenitis, inflammation of the lips and oral

cavity, and erythema and edema of the hands andfeet.

Kawasaki disease is the most common cause ofacquired heart disease in children in developed

countries. Coronary artery aneurysms develop in 15% to 25%

of untreated children and may lead to ischemic heartdisease or sudden death.


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Principalclinical features for diagnosis of Kawasaki disease

1-Fever persisting at least 5 days

2-Changes in extremities:

a-Erythema of palms and soles; edema of hands and feet

b-Periungual peeling of fingers and toes in weeks 2 and 3

3-Polymorphous exanthema. Rash which may take many forms, but not

vesicular (blister-like), on the trunk.4-Bilateral conjunctival injection without exudate, also known as "conjunctival

injection.

5-Changes in the lips and oral cavity. Strawberry tongue, white coating on the

tongue or prominent red bumps (papillae) on the back of the tongue

6-Cervical lymphadenopathy (


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Cardiovascular system involvement in Kawasakis

syndrom is the most significant long termsequellae, like:

coronary artery aneurysm

myocardial dysfunction

pericardial effusion

mitral and aortic valve involvement

atrio-ventricular block etc.


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Coronary angiogram showing irregular and dilated left main coronary artery

and aneurysm of left circumflex coronary artery.


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X-ray showing Aneurysmal enlargement of the coronary arteries

, which is the most feared

complication in a Kawasaki syndrome


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Aim to study

To review the cardiovascular

involvement in Kawasakis syndromin our patients


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Materials and Methodes.

All the children infected by Kawasakis syndrom

hospitalised in our pediatric hospital are

enrolled in this study.

Clinical features, physical examination,laboratory tests including CRP,ESR, hematocrit,

thrombocit, electrocardiograme, chest X-ray and

especially echocardiograme were analyzed forall patients.


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A coronary artery is classified as abnormal if:

the internal diameter is greater than 3mm in

children younger than 5 years or 4mm inchildren 5 years of age or older,

the coronary artery lumen is irregular.


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All patients with Kawasakis syndrom were

treated with immunoglobulin for 5 days

associated with aspirin.


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For all patients the first cardiac examination

was made in the first 10 days of the illness.

Patients with cardiac touch was systematicallysearched every 2 weeks during the first 2

months and then every 3 months during the

first year after disease.


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Results

13 children were hospitalised with Kawasakis

syndrom during the periode January 2000-

December 2008.

The mean age 2.8 years (range 11months-5years) 8 male, 5 female.

2 patients (age 2 years male and 4 years -

female) were diagnosed with left ventriculardysfunction with cardiomegaly (FS=23% and

24%).


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1patient (age 11months-male) had a small

aneurysm fusiform of the right coronary artery.

We have not had any case myocarditis andpericarditis with or without effusion, or AV

block.


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Left ventricular function was normalizedafter 4-5 weeks and the aneurism after 3

months.

We have used expect immunoglobulin,aspirin for 2 cases with left ventricular

dysfunction for about 3 months and in

case with aneurism of the coronary for 6

months after the onset of disease.


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Conclusion

Cardiovascular involvement is the most serious

complication of Kawasakis Disease;

the most frequent left ventricular

dysfunction and aneurism of the coronary

artery.

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CARDIOVASCULAR INVOLVEMENT IN KAWASAKI’S SYNDROM1