coronary artery aneurysm

Kawasaki disease (KD) is an acute, self-limiting vasculitis that predominantly affects children under five years of age. It is recognized as the leading cause of acquired coronary artery disease in this age group.

This manuscript presents two cases of KD complicated by significant coronary artery abnormalities, which ultimately necessitated heart transplantation.

Emphasizing the importance of early diagnosis and treatment, this study underscores the critical need for continued research to improve outcomes for affected patients.

Multisystem Inflammatory syndrome in Children (MIS-C) is a common diagnosis among children in the post Covid-19 era, which usually presents with fever and varied systemic manifestations. BCG vaccination site reaction as a manifestation of MIS-C is barely ever documented. In this series, we present a rare such case report along with the other six other cases.

Seven cases with MIS-C are presented with four male and three female children. The median age of presentation was 3 (range: 0.4-14) years. Fever was the most common (100%) symptom followed by muco-cutaneous manifestation (50%, 4/7), as well as gastrointestinal (37.5%, 3/7), and cardiovascular symptoms (37.5%, 3/7). The clinical features which led to the diagnosis include BCG site vaccination, erythema multiforme, periungual and perineal peeling, unilateral knee joint effusion, skin scalding syndrome, urticaria, and acute glomerulonephritis. The initial work-up for fever did not yield any cause, except for a non-specific elevation of inflammatory markers. 6 cases had elevated anti-SARS-Co-V2 antibody titres with a negative RTPCR/RAT test and 1 case yielded positive RTPCR for covid status for acute infection. 2D Echocardiography showed Coronary artery dilatation in two patients which resolved on follow-up. All the patients responded well to intravenous immunoglobulin and methylprednisolone combination therapy with antiplatelet drugs.

BCG vaccination site reaction could occur due to antigen-homology. Cardiovascular manifestations (coronary artery dilatation) without hemodynamic instability may also be a manifestation of MIS-C, thereby placing 2D-Echo as an important step in diagnostic workup.

 The epidemiology of Kawasaki disease (KD) suggests that an infectious agent may be a potential disease trigger in susceptible children. Several studies have shown that the cause of KD may be associated with Mycoplasma pneumoniae (M. pneumoniae) infection.

 We aimed to investigate the relationship between M. pneumoniae infection and coronary artery aneurysm (CAA) in children with KD in China.

 From January 2015 to December 2018, a total of 330 children with KD met the inclusion criteria. Relevant data were extracted and analysed.

 The children were stratified into two groups according to M. pneumoniae infection status. Significant differences were identified in the proportion of patients with fever > 10 days, the occurrence of small CAA, and the average serum sodium, pre-albumin (PA), and albumin levels but not in the occurrence of medium and giant CAA between the two groups. According to binary logistic regression, M. pneumoniae infection (OR: 0.515; 95% CI: 0.309 - 0.860; P = 0.011), serum sodium levels (OR: 0.910; 95% CI: 0.851 - 0.972; P =0.005), and PA (OR: 0.900; 95% CI: 0.854 - 0.949; P ≤ 0.001) levels were independently associated with occurrence of small CAA.

 We demonstrated that M. pneumoniae infection, serum sodium and PA levels are inversely related to the occurrence of small CAA. These results suggest that M. pneumoniae infection may be associated with a decreased incidence of small CAA. Further large-sample studies are needed.

Background Kawasaki disease (KD) also known as mucocutaneous lymph node syndrome is the febrile and self-limited vasculitis that occurs in children of all ages, especially younger than five years of age. Here, we describe a case of Kawasaki disease with coronary artery aneurysm and a big clot in LV with a diameter of 1.5 cm. Case Presentation In February 2019, a 10-month-old boy with a complaint of weakness and lethargy was referred to Imam Reza hospital in Mashhad (Iran). The patient has had coughs with no response to drug treatment for the past four months. Gallop rhythm was present in heart auscultation. Hepatomegaly was observed in physical examination. No lymphadenopathy was seen, but scalded skin was observed. On the second day of hospitalization in our center, he developed non-purulent bilateral conjunctivitis, strawberry tongue, and maculopapular rashes on the body and distal parts of the limbs. Echocardiography showed dilation of the heart chamber, blood clot in the left ventricle (LV) with the size of 1.5 cm, moderate to severe tricuspid regurgitation (TR), giant aneurysm (0.8 cm) in the left anterior descending coronary artery (LAD), right coronary artery (RCA) aneurysm (0.6 cm), and decreased ejection fraction (EF). Conclusion Kawasaki disease must be considered in the differential diagnosis of patients presenting symptoms of infection including fever and weakness, especially in infants. Early diagnosis of Kawasaki disease can lower the chance of complication including coronary artery aneurysms. Therefore, this disease must be permanently considered in patients (especially in infants) with long-term fever without a typical presentation of Kawasaki to avoid severe heart complications.

Kawasaki disease (KD) is a systemic vasculitis syndrome usually presented with acute fever which occurs primarily in children younger than 5 years of age. KD has become the most common cause of acquired heart disease in pediatric population in developed countries. Kawasaki disease can damage cardiovascular system including myocarditis, pericarditis, coronary artery aneurysms complicated by thrombotic or stenotic lesions that are at risk of myocardial infarction (MI), congestive heart failure and also sudden cardiac death. The incidence of such complications can be dramatically reduced by early diagnosis and intravenous immunoglobulin (IVIg) therapy and high dose aspirin.

A 25-year-old man with a history of Kawasaki disease 17 years ago presented with anterior ST-segment elevation myocardial infarction (STEMI), left anterior descending artery (LAD) and right coronary artery (RCA) aneurysmal dilation and thrombosis with left ventricle ejection fraction (LVEF) of 25% that underwent coronary artery bypass graft (CABG) surgery and surgical closure of coronary artery aneurysms.

The surgical management of cardiac disease in Kawasaki patients could be safe and effective.

Gyrate atrophy of the choroid and retina is a metabolic disorder, which is inherited in an autosomal recessive pattern. Although gyrate atrophy is rare, it is concerning as it results in blindness. It is characterized by hyperornithinemia, retinal atrophy, leads to progressive myopia and tunnel vision, and Posterior Subcapsular Cataracts. Patients have lower amounts of ornithine aminotransferase.
In this study, we report a 17-year-old boy referred to our hospital by an ophthalmologist, with progressive visual loss from 7 years of age. The eye examinations manifested chorioretinal degeneration and high myopia. In lab data, plasma ornithine amount was elevated 10-fold higher than normal. By this finding, he was diagnosed as having Gyrate Atrophy. Treatment with pyridoxine and low arginine diet can reduce the ornithine plasma level in Gyrate Atrophy. Our report is to describe the first case of gyrate atrophy in pediatric endocrinology department in Iran diagnosed by biochemistry and treated with pyridoxine and low arginine diet.

Coronary aneurysms are typically seen in association with Kawasaki disease and only in rare instances, they are reported to be congenital or idiopathic. Here we report a case of a five year old boy who was found to have an idiopathic right coronary artery aneurysm. He presented with complaints of recurrent respiratory tract infections. His examination and investigations did not reveal any of the common etiological conditions. Echocardiography showed the right coronary artery was arising from the right coronary sinus and was dilated proximally. Cardiac catheterization revealed dilated proximal right coronary artery draining into a large pulsatile aneurysm. The child was surgically treated with an aorto-caval bypass, resection and surgical ligation of the aneurysm. He has no further complications and is on follow up.

Surgical revascularization for coronary artery lesions secondary to Kawasaki disease (KD) has been rarely reported in adolescent patients. We report a young adult with no coronary risk factors but with a giant solitary coronary aneurysm with obstructive thrombosis inside, presumably secondary to KD, who underwent coronary artery bypass grafting (CABG) with left internal thoracic artery (LITA) and SVG.Because coronary artery sequelae of KD can be a cause of ischemic heart disease even in young adults, heightened awareness of this entity is required for young adults with coronary lesions but without coronary risk factors.

Kawasaki disease is an acute vasculitis of childhood that predominantly affects the coronary arteries. The etiology of Kawasaki disease remains unknown, although an infectious agent is strongly suspected based on clinical and epidemiologic features. A genetic predisposition is also likely, based on varying incidences among ethnic groups, with higher rates in Asians. Symptoms include fever, conjunctival injection, erythema of the lips and oral mucosa, rash, and cervical lymphadenopathy. Some children with Kawasaki disease develop coronary artery aneurysms or ectasia, ischemic heart disease, or sudden death. Kawasaki disease is the leading cause of acquired heart disease among children in developed countries. This article provides a summary of the history, etiology, clinical diagnosis, treatment guidelines and lifelong follow up of KD.

Case Report: Coronary artery aneurysm is a relatively infrequent abnormality but its diagnosis has been increased after the advent of coronary angiography. Atherosclerosis accounts for the majority of cases of coronary aneurysms. Other etiologies include congenital aneurysms, dissection, infection, vasculitis, and some other inflammatory conditions. We describe a 41-year-old woman who presented with typical chest pain and dyspnea and had multiple small and large coronary aneurysms associated with stenotic segments