title: The Spectrum of Cardiovascular Lesions Requiring Intervention in Adults After Kawasaki Disease.
abstract: OBJECTIVE
  The aim of this study was to characterize the range of management issues raised by adults with cardiovascular sequelae from Kawasaki disease (KD) in childhood.
  
  
  BACKGROUND
  Aneurysms resulting from vascular inflammation associated with KD in childhood may remain clinically silent until adulthood. Adults with large aneurysms, unstable angina, or myocardial infarction following KD in childhood present unique challenges to interventional cardiologists and cardiothoracic surgeons.
  
  
  METHODS
  In an observational study of adults with histories of KD in childhood, data were collected regarding the medical histories and outcomes of 154 adult KD patients, of whom 21 underwent either percutaneous interventions or surgery.
  
  
  RESULTS
  Of the 21 subjects with interventions, 11 had been diagnosed with KD in childhood, and 10 had histories of KD-compatible illnesses. Seventeen subjects were asymptomatic until experiencing acute cardiovascular symptoms: acute myocardial infarction (n = 12), angina (n = 2), end-stage congestive heart failure requiring cardiac transplantation (n = 1), and claudication (n = 2).
  
  
  CONCLUSIONS
  Cardiovascular complications in these subjects illustrate the following points: 1) even small to moderate-sized aneurysms that "normalize" on echocardiography in childhood can lead to stenosis and thrombosis decades after the acute illness; 2) coronary interventions without intravascular ultrasound may result in clinically significant underestimation of vessel luminal diameter; 3) failure to assess the extent of calcification may lead to suboptimal procedural outcomes; and 4) patients with symptomatic peripheral aneurysms may benefit from endarterectomy or resection. Interventional cardiologists should be aware of the potential challenges in treating this growing population of adults.
authors.affiliation: San Diego Cardiac Center and Sharp Memorial Hospital, San Diego, California. Electronic address: jgordon552@mac.com.
authors.forename: John B
authors.initials: JB
authors.lastname: Gordon
authors.affiliation: Department of Medicine, University of California, San Diego, School of Medicine, La Jolla, California.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: Department of Medicine, University of California, San Diego, School of Medicine, La Jolla, California.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kahn
authors.affiliation: Department of Pediatrics, Rady Children's Hospital San Diego and the University of California, San Diego, School of Medicine, La Jolla, California.
authors.forename: Susan
authors.initials: S
authors.lastname: Jimenez-Fernandez
authors.affiliation: Department of Pediatrics, Rady Children's Hospital San Diego and the University of California, San Diego, School of Medicine, La Jolla, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Vejar
authors.affiliation: Department of Pediatrics, Rady Children's Hospital San Diego and the University of California, San Diego, School of Medicine, La Jolla, California.
authors.forename: Fujito
authors.initials: F
authors.lastname: Numano
authors.affiliation: Department of Pediatrics, Rady Children's Hospital San Diego and the University of California, San Diego, School of Medicine, La Jolla, California.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Burns
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000787:Angina Pectoris / Q000209:etiology / Q000628:therapy; D001706:Biopsy; D006328:Cardiac Catheterization / Q000009:adverse effects; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D016027:Heart Transplantation; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000175:diagnosis; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult
keywords: claudication; coronary artery aneurysm; pediatric acquired heart disease; percutaneous coronary intervention; vasculitis