title: Cardiovascular pathology in 2 young adults with sudden, unexpected death due to coronary aneurysms from Kawasaki disease in childhood.
abstract: OBJECTIVE
  Coronary artery aneurysms (CAA) may remain silent after Kawasaki disease (KD) until adulthood when myocardial ischemia can lead to sudden death. We postulated that there would be young adults with sudden, unexpected death due to CAA from KD who would have a state-mandated autopsy performed by the San Diego County Medical Examiner's Office (SDCMEO).
  
  
  METHODS
  We reviewed all autopsy cases <35years of age from 1997 to 2012 at the SDCMEO with a cardiovascular cause of death (n=154).
  
  
  RESULTS
  We found 2 cases meeting inclusion criteria. Case 1 was a 22-year-old Korean male with chronic ischemic changes due to a partially occluded and diffusely calcified 15mm aneurysm at the bifurcation of the left main coronary artery. Interview of the mother revealed that this patient had been diagnosed with KD complicated by giant aneurysms at age two years. Case 2 was a 30-year-old Hispanic male with myocardial infarction due to thrombosis of a calcified left anterior descending artery aneurysm. Histologic findings included diffuse myocardial fibrosis and a recanalized aneurysm in the right coronary artery. Interview of the family revealed a KD-compatible illness in childhood. Immunohistochemical staining showed expression of transforming growth factor β pathway molecules in the aneurysmal arterial wall.
  
  
  CONCLUSIONS
  In a medical examiner's office serving a population of approximately 3 million people, 2 of 154 (1.3%) cardiovascular deaths in persons <35years were attributed to cardiovascular complications of KD in childhood. Antecedent KD should be considered in the evaluation of all cases of sudden, unexpected death in young adults.
authors: Dept. of Pediatrics, UCSD School of Medicine, La Jolla, CA, USA. Electronic address: c1shimizu@ucsd.edu.
authors: Chisato
authors: C
authors: Shimizu
authors: Dept. of Pediatrics, UCSD School of Medicine, La Jolla, CA, USA.
authors: Alka
authors: A
authors: Sood
authors: Dept. of Pediatrics, UCSD School of Medicine, La Jolla, CA, USA.
authors: Hubert D
authors: HD
authors: Lau
authors: Toho University Ohashi Medical Center, Tokyo, Japan.
authors: Toshiaki
authors: T
authors: Oharaseki
authors: Toho University Ohashi Medical Center, Tokyo, Japan.
authors: Kei
authors: K
authors: Takahashi
authors: Rady Children's Hospital San Diego, San Diego, CA, USA.
authors: Henry F
authors: HF
authors: Krous
authors: San Diego County Medical Examiner's Office, San Diego, CA, USA.
authors: Steven
authors: S
authors: Campman
authors: Dept. of Pediatrics, UCSD School of Medicine, La Jolla, CA, USA; Rady Children's Hospital San Diego, San Diego, CA, USA.
authors: Jane C
authors: JC
authors: Burns
mesh_terms: D000328:Adult; D003323:Coronary Aneurysm / Q000209:etiology* / Q000473:pathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications*; D055815:Young Adult
keywords: Autopsy; Coronary artery aneurysm; Kawasaki disease; Myocardial fibrosis; Sudden death; Transforming growth factor beta