日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

We report two cases of coronary aneurysms that were not previously diagnosed during acute illness but were discovered for the first time during school cardiac screening (SCS).

Case 1 was a 6-year-old boy who had successful immunoglobulin treatment for typical Kawasaki disease (KD) at the age of 3. Though an echocardiographic examination during acute phase was reported as normal, echocardiography at SCS demonstrated giant left coronary aneurysms separated by coronary artery stenosis. Consequently, the patient was placed on oral warfarin and underwent percutaneous coronary angioplasty and coronary artery bypass surgery.

Case 2 was a 13-year-old boy who had a 9-day history of fever with several signs of KD and had been receiving treatment for juvenile idiopathic arthritis at 9 years of age. Though an echocardiographic examination at 9 day of the illness was reported as normal, echocardiography at SCS demonstrated a moderate sized left coronary artery aneurysm that was thought to be a sequela of incomplete KD. Consequently, the patient was administered oral aspirin and was regularly followed-up.

These cases illustrates that SCS may present an important opportunity to diagnose coronary aneurysm in patients with a history of complete or incomplete KD. As the presence of coronary aneurysms significantly alters treatment and prognosis, guidelines for echocardiography quality control and the proper timing of echocardiography in patients with incomplete KD are required.