kawasaki%20disease
KAWASAKI DISEASE
Kawasaki disease is an acute, febrile illness that is self-limited. It is a systemic vasculitic syndrome that primarily involves the medium- and small-sized muscular arteries of the body.
It is also known as mucocutaneous lymph node syndrome.
It affects primarily children <5 years old with peak incidence in 1-2 year of age.
The cause remains unknown but current research supports an infectious origin.
Epidemiological findings suggest that genetic predisposition and environmental factors play a role in the pathogenesis of the disease.

Surgical Intervention

Coronary Artery Bypass Grafting (CABG)

  • May be effective in patients who have severe occlusive lesions in main coronary arteries (especially in the central portions) or rapidly progressive lesions w/ evidence of myocardial ischemia
  • Indications for procedure in children have not been established in clinical trials but should be considered when:
    • Reversible ischemia is present on stress-imaging test results
    • Myocardium to be perfused through the graft is still viable
    • No appreciable lesions are present in the artery distal to the planned graft site
  • Findings of coronary angiography for which surgical treatment should be considered:
    • Severe occlusive lesions in the main trunk of the left coronary artery
    • Severe occlusive lesions in multiple vessels (2-3 vessels)
    • Severe occlusive lesions in the distal portion of the left anterior descending artery
    • Jeopardized collaterals
  • Preferable to perform coronary artery bypass grafting (CABG) using autologous pedicle internal mammary artery grafts regardless of age

Mitral Valve Surgery

  • Valvuloplasty & valve replacement may be indicated for patients w/ chronic, severe mitral insufficiency not responding to medical treatment

Cardiac Transplantation

  • Should be considered only for individuals w/ severe, irreversible myocardial dysfunction & coronary lesions for which interventional catheterization &  coronary artery bypass grafting (CABG) are not feasible
  • Beneficial in patients w/ significant left ventricular dysfunction & who have life-threatening arrhythmia & significant lesions in peripheral segments of the coronary arteries

Percutaneous Coronary Intervention (PCI)/ Cardiac Catheterization

  • Recommended in the following patients:
    • W/ ischemic symptoms
    • W/o ischemic symptoms but w/ reversible ischemia on stress test
    • W/o ischemia but w/ ≥75% stenosis in the left anterior descending (LAD)
  • Contraindicated in patients who have vessels w/ multiple, ostial or long-segment lesions
  • Not indicated for patients w/ left heart dysfunction

Balloon Angioplasty

  • Feasible in young children in whom stenting & rotational ablation are difficult because of small body size
  • Excellent efficacy in coronary stenotic lesions ≤6 years

Rotational Ablation

  • Most optimal technique for coronary stenotic lesions during the remote phase of Kawasaki disease since it can obtain a larger lumen at locations w/ highly calcified lesions
  • Difficult to perform in small children due to use of guiding catheters

Stent Placement

  • Effective in older children in whom calcification of coronary lesions is relatively mild
  • Also effective in the treatment of coronary arteries in which aneurysms & stenosis are present in succession
  • Useful in children w/ giant aneurysms
  • Important to continue antithrombotic & antiplatelet therapies after stenting to avoid the development of thrombotic occlusion
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