Korean Circ J.  2014 Jan;44(1):54-58. 10.4070/kcj.2014.44.1.54.

Two Cases of Super-Giant Coronary Aneurysms after Kawasaki Disease

• Lee J
• Kim GB
• Kwon BS
• Bae EJ
• Noh CI

• KMID: 1859244
• DOI: http://doi.org/10.4070/kcj.2014.44.1.54

Abstract

Acute giant coronary aneurysm after Kawasaki disease (KD) is a catastrophic complication that can be fatal and very difficult to manage. However, no fixed consensus has been reached for the management of super-giant coronary aneurysms in the acute setting. Here, we report the successful management of young children with super-giant coronary aneurysms after KD. Based on our experience, hemodynamic stabilization to prevent further coronary dilation or rupture and strict anticoagulation to avoid thrombus formation are mandatory in the management of this condition.

Keyword

Kawasaki disease; Coronary aneurysm; Coronary thrombosis; Coronary artery disease

MeSH Terms

Child
Consensus
Coronary Aneurysm*
Coronary Artery Disease
Coronary Thrombosis
Hemodynamics
Humans
Mucocutaneous Lymph Node Syndrome*
Rupture
Thrombosis

Figure

• 

  Fig. 1 Case 1, initial echocardiogram. A: the RCA showed marked dilatation (16 mm) with thrombus formation. B: the left coronary artery also had a giant aneurysm containing a thrombus in the LAD (9.9 mm). RCA: right coronary artery, LAD: left anterior descending artery, LCX: left circumflex artery.

• 

  Fig. 2 Case 1, follow-up echocardiogram and computed tomography (CT). A: the RCA showed disappearance of the thrombus; however, a rather giant aneurysm (16.4 mm) was still present 5 months after treatment. B: cardiac CT revealed a tortuous and giant RCA aneurysm (18 mm) without significant thrombus formation. The left coronary artery was also dilated. RCA: right coronary artery, LAD: left anterior descending artery.

• 

  Fig. 3 Case 2, initial echocardiogram and computed tomography (CT). A: the RCA showed a marked giant aneurysm (23 mm) with thrombus formation and with a diameter greater than that of the aorta. The left coronary artery also had a giant aneurysm in the LAD (16.8 mm) containing mural thrombus. B: cardiac CT revealed blood stagnation in the RCA. RCA: right coronary artery, LAD: left anterior descending artery, Ao: aorta.

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  Fig. 4 Case 2, selective RCA angiogram. A: the RCA angiogram 2 months after treatment showed a marked giant aneurysm with blood stasis. B: a RCA angiogram of the giant aneurysm showed occlusion at its distal portion (dotted arrow). RCA: right coronary artery.

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