Coronary Aneurysms in Kawasaki Disease
Coronary Aneurysms in Kawasaki Disease
Web: https://johnsonfrancis.org/profession… Discussion on coronary aneurysms in Kawasaki disease.
Coronary aneurysms can be defined as localized dilatation of the coronary artery of more than 1.5 times compared to the adjacent coronary segment. In children, the classification is often based on Z score.
Content
0.48 -> Discussion on coronary
aneurysms in Kawasaki disease.
5.12 -> Coronary aneurysms can be defined as
localized dilatation of the coronary artery
10.48 -> of more than 1.5 times compared to the
adjacent coronary segment. In children,
16.4 -> the classification is often based on Z score.
Z-score is the standard deviation from coronary
23.2 -> artery internal lumen diameter
normalized for body surface area.
27.92 -> AHA classification of coronary artery
aneurysms based on Z-score is as follows:
34.48 -> 1. No involvement with Z score less than 2 always.
2. Dilatation only with Z scores from 2 to less
44.08 -> than 2.5 or a decrease in Z score of 1 or more
during follow up if it was less than 2 initially.
53.36 -> 3. Small aneurysm with Z score of
more than 2.5, but less than 5.
60.08 -> 4. Medium aneurysm with Z score 5 or more, but
less than 5 and absolute dimension less than 8 mm.
69.2 -> 5. Large or giant aneurysm with Z score 10
or more or absolute dimension 8 mm or more.
77.6 -> The decrease in dimension in Class 2 over time
means that though the diameter was in normal
83.68 -> range initially, it was actually dilated for
that person and decreases in size over time.
91.76 -> Reference for AHA guidelines 2017.
A previous Japanese guideline classified coronary
99.6 -> aneurysms in acute phase of Kawasaki disease based
on absolute or relative internal lumen diameter.
108.08 -> In that classification,
small aneurysm or dilatation
112.08 -> was a localized dilatation with internal diameter
4 mm or less. In children of 5 years or more,
120.08 -> internal diameter of a segment measures
less than 1.5 times the adjacent segment.
125.76 -> Medium aneurysm was with internal diameter above
4 mm, up to 8 mm. In children of 5 years or more,
135.04 -> internal diameter of a segment measures
1.5 to 4 times that of an adjacent segment.
141.12 -> Giant aneurysm was with internal diameter
above 8 mm. In children 5 years or more,
147.84 -> internal diameter of a segment measures more
than 4 times that of an adjacent segment.
152.96 -> This classification is easier to follow as
you need not check the nomogram for Z scores
159.6 -> each time you do an echocardiographic
measurement of the coronary arteries.
164.08 -> Disadvantage of course is that the
variation in coronary size with age
168.48 -> is not fully accounted for.
A study by Suda K et al
173.68 -> found 76 patients with giant coronary aneurysms
from their institutional database since 1972.
182.16 -> The average age at onset was about 3 years and
the median follow up was about two decades.
188.96 -> Seven of them died and one underwent cardiac
transplantation over the follow up period.
194.56 -> The survival rates calculated were 95%
at ten years and 88% at thirty years.
202.48 -> About two thirds of them had undergone surgical
or catheter based interventions to alleviate
208.64 -> coronary ischemia. The authors call for further
research on the role of coronary interventions
214.96 -> in those with coronary aneurysms
following Kawasaki disease.
219.28 -> Factors which favour regression of
coronary aneurysms in Kawasaki disease:
224.64 -> Age less than one year at
onset of Kawasaki disease
228.56 -> Smaller aneurysms have a
greater chance of regression
232.4 -> Distal aneurysms are more likely to regress
236.08 -> Fusiform aneurysms regress more
often than saccular aneurysms
242.4 -> Here is the relevant reference.
246.08 -> Overall, about half to two thirds of
coronary aneurysms in Kawasaki disease
251.52 -> have been shown to regress on angiography
within one to two years of onset of illness.
257.44 -> In contrast to coronary aneurysms
which can regress with time,
261.68 -> stenotic lesions are more likely to progress as
they are due to intense myointimal proliferation.
269.36 -> Progression of stenotic lesions are more
likely in those with giant aneurysms.
275.28 -> Worst prognosis is for those with giant
aneurysms of 8 mm or more diameter.
281.68 -> Though echocardiography is the most commonly used
investigation for aneurysms in Kawasaki disease
288.4 -> and coronary angiography the gold standard,
MDCT is a useful non-invasive modality
295.28 -> for long term follow up.
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Source: https://www.youtube.com/watch?v=jInwhnVbfPA