Abstract
Kawasaki disease (KD) is an acute, self-limited vasculitis of childhood. It can result in coronary artery aneurysms in 25% of patients, especially if the diagnosis is missed. Echocardiography is the imaging modality of choice for diagnosis of coronary artery involvement and evaluation of myocardial function. Serial echocardiography is necessary in order to detect thromboses in aneurysms especially in patients with giant aneurysm.
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Keywords
Kawasaki Disease (KD)
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Evaluate left main coronary artery (LMCA), left anterior descending (LAD), and Left circumflex (LCX) in multiple imaging planes. Start with parasternal short axis view to see the origin of both LMCA and RCA. Then with slight rotating and tilting of transducer follow the LAD and LCX length from bifurcation. Assess the distal LAD in parasternal long axis and subcostal coronal views and follow the LCX length in atrioventricular groove in apical four chamber view.
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Follow RCA course in parasternal long axis and also in apical and subcostal sagittal and coronal views.
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Evaluate the internal dimension of coronary arteries from the inner edge to inner edge of the vessel wall and do not measure at the level of its normal branching. Evaluate Z scores of LAD, RCA, and LMCA. Remember that most frequently coronary artery aneurysms develop in the LMCA and proximal segments of the LAD and the RCA (Fig. 36.1a, b).
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Assess any ectasia, the internal diameter of coronary arteries should be less than 3 mm in children younger than 5 years old and less than 4 mm thereafter, otherwise it is considered coronary ectasia
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Appreciate perivascular brightness, lack of normal tapering, segmental dilation, or narrowing of coronary arteries. If the internal diameter of a segment is 1.5 times that of the adjacent segment it is abnormal
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Appreciate any mitral, tricuspid and aortic valve regurgitation
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Pay attention to any LV or RV systolic and diastolic dysfunction and regional wall motion abnormality.
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Evaluate even minimal pericardial effusion.
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Number, size (small <5 mm, medium 5–8 mm, or giant >8 mm in internal diameter), location, and shape (fusiform or saccular) of every aneurysm should be described.
Suggested Reading
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Friedman KG, Gauvreau K, Hamaoka-Okamoto A, et al. Coronary artery aneurysms in Kawasaki disease: risk factors for progressive disease and adverse cardiac events in the US Population. J Am Heart Assoc. 2016;5:e003289.
McCrindle BW, Cifra B. The role of echocardiography in Kawasaki disease. Int J Rheumatic Dis. 2018;21(1):50–5.
McCrindle BW, Li JS, Minich L, et al. Coronary artery involvement in children with Kawasaki disease risk factors from analysis of serial normalized measurements. Circulation. 2007;116:174–9.
McCrindle BW, Rowley A, Newburge JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135:e927–99.
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Moradian, M. (2021). Kawasaki Disease (KD). In: Moradian, M., Alizadehasl, A. (eds) Atlas of Echocardiography in Pediatrics and Congenital Heart Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-62341-1_36
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DOI: https://doi.org/10.1007/978-3-662-62341-1_36
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