Mucocutaneous lymph node syndrome: Clinical, hemodynamic and angiographic features of coronary obstructive disease

Abstract

Clinical, hemodynamic and angiographic features of coronary obstructive disease (≥ 90% diameter reduction) in Kawasaki disease were evaluated in 30 patients. The mean age at the onset of Kawaski disease was 2.9 ± 1.9 years and that at cardiac catheterization was 6.3 ± 2.8 years. Obstructive lesions were observed in the right coronary artery in 12 patients (group 1), in the left anterior descending coronary artery (LAD) in 6 (group 2), in both right coronary artery and LAD in 10 (group 3) and in the left main coronary artery in 4 (group 4). Twenty-two patients (73%) had cardiac symptoms, including myocardial infarction in 10 (33%). Cardiac symptoms were observed in 41 % in group 1, 100% in group 2, 80% in group 3 and 100% in group 4. Left ventricular (LV) end-diastolic pressure, enddiastolic volume and ejection fraction were abnormal in 32% of the patients in group 1, a frequency less than that in other groups (83% in group 2, 78%. in group 3 and 100% in group 4). Fifty percent had mitral regurgitation and 73% had left ventricular wall motion abnormalities. No patient in groups 1 or 2 has died, but 8 of 14 patients in groups 3 and 4 have died. These observations indicate that coronary obstruction owing to Kawasaki disease can cause depressed LV function, mitral regurgitation and LV wall motion abnormalities in children. Clinical and hemodynamic features of right coronary obstruction (isolated) are relatively benign compared with those of left coronary obstruction (isolated or combined with right obstruction).