Two Adult Cases of Coronary Artery Aneurysms Secondary to Kawasaki Disease

Abstract

Case 1 was a 20-year-old male with no coronary risk factors. He had a history of KD at the age of 3 years and had received adequate treatment with gamma globulin for KD. Angiography 1 month after the onset of KD showed a coronary artery aneurysm in the left anterior descending artery (LAD). Subsequently, he was followed up regularly without any symptoms. At the age of 19 years, he developed dyspnea on exertion. Subsequent coronary angiography revealed an aneurysm of the LAD with severe stenosis in both the proximal and the distal portion of the aneurysm ([ Fig. 1 a ]). CT scan showed an aneurysm with a size of 12 × 19 mm. The patient underwent on-pump CABG with the right internal thoracic artery (RITA) anastomosed to the distal LAD and the left internal thoracic artery (LITA) anastomosed to the diagonal branch. The postoperative course was uneventful and multi-detector computed tomography (MDCT) demonstrated patent grafts ([ Fig. 2 ]). Fig. 1 a and b a Selective left coronary angiogram of case 1 showing an aneurysm and severe stenosis in the proximal portion of the left anterior descending artery. b Selective right coronary angiogram of case 2 showing occlusion of the RCA and bridging collaterals running over the aneurysm. Fig. 2 Postoperative MDCT of case 1 showing the patent grafts of the RITA anastomosed to the distal LAD and the LITA to the diagonal branch. Case 2 was a 30-year-old male with a history of KD at the age of 3 months and gamma globulin treatment. The first angiography, taken at the age of 10 years, revealed a right coronary artery (RCA) aneurysm. Although he was well until the age of 28 years, he developed exertional chest pain. The angiography showed occlusion of the proximal RCA and bridging collaterals which ran over the occluded RCA aneurysm (26 × 30 mm in size on CT) and severe stenosis (75 %) of the proximal portion of the LAD ([ Fig. 1 b ]). On-pump CABG was carried out. The LAD was bypassed with the LITA and the RCA with the radial artery (RA). His postoperative recovery was uneventful. The postoperative angiography demonstrated patency of the grafts ([ Figs. 3 a, b ]). Fig. 3 a and b Postoperative angiogram of case 2 showing a patent LITA graft to the LAD.