Management of severe coronary sequelae of Kawasaki disease

Thirty-four patients with severe coronary sequelae of Kawasaki disease were prospectively investigated. Complications included giant coronary aneurysm (15 patients), coronary obstruction (11), stenosis (2) and surgical patients (6). The patients had been managed for four years according to our own follow-up schedule in which we carried out for example treadmill stress tests two or three times a year and myocardial imaging once a year. One patient died after surgery during the observation period while jogging at school. Although his bypass grafts were patent, treadmill tests and myocardial imaging revealed that he had ischemia. Five patients were newly diagnosed with ischemia by treadmill tests and myocardial imaging, and all underwent bypass surgery. Even after successful surgery, it was necessary to wait for normal ischemic findings in some patients. We conclude that serial treadmill stress tests and myocardial imaging are mandatory in managing severe coronary sequelae of Kawasaki disease. Restriction of daily activity and exercise is also necessary after diagnosis of ischemia by treadmill tests.