Abstract
Objective: To study the evolution of coronary arterial lesions during the acute and subacute phases of Kawasaki disease by echocardiography. Method: The study was done retrospectively from 1st July 1994 to 30th June 2000. In our protocol, echocardiography is done for acute cases at presentation, on Day 14 (2 weeks), Day 28 (4 weeks) and Day 56 (8 weeks) of fever. Only cases that presented early, within 10 days of fever, were included. The echocardiographic findings throughout the first 8 weeks of the disease were reviewed to study the evolution of coronary arterial lesions. Those with positive coronary lesions were divided into 2 groups, one with early lesions detected at presentation and the other with lesions appearing at or after 2 weeks from the onset. Their demographics and clinical course were compared. Results: A total of 611 patients, mostly Chinese, aged 1.2 months to 15.4 years were identified. The majority of patients (90.2%) had received intravenous gammaglobulin (IVGG) within 10 days. Coronary arterial lesions in form of ectasia or aneurysms have been found in 112 patients (18.3%). Only 4.4% of patients had coronary lesions at presentation. Most new lesions (12.9%) were detected at 2-week echo follow-up. New lesions were rare after 4 weeks. Coronary lesions began to regress since 2 weeks from onset and continued to regress at similar rate (37-41%) at each 2-week follow-up. By the end of 8 weeks, 63.4% of all the lesions had regressed and only 6.9% of patients continued to have them. The group with early coronary arterial lesions had more male patients, required more doses of IVGG while the one with later lesions had more cases not requiring IVGG. However, their age distribution, duration of fever, frequency of atypical presentation and severity of coronary lesions were similar. These data may guide our future management plan.
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Lee, S., Chiu, W., Ho, M. et al. Evolution of Coronary Arterial Lesions during the Acute Phases of Kawasaki Disease in Children and Adolescents. Pediatr Res 53, 177 (2003). https://doi.org/10.1203/00006450-200301000-00142
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DOI: https://doi.org/10.1203/00006450-200301000-00142