Aneurismas gigantes de las arterias coronarias en la enfermedad de Kawasaki Nuestra casuística

Overview

Kawasaki disease is an acute febrile vasculitis of unknown etiology that predominantly affects male children under five years of age. The condition is characterized by fever, cutaneous rash, conjunctivitis, mucosal inflammation, cervical lymphadenopathy, and desquamation of extremities. The long-term morbidity and mortality are primarily determined by coronary artery involvement, specifically the development of coronary aneurysms. Giant coronary aneurysms, defined as those with internal diameter exceeding 8 mm, represent a severe sequela with significant prognostic implications.

Methods and approach

Echocardiography serves as the fundamental diagnostic modality for evaluation and longitudinal follow-up of coronary abnormalities in Kawasaki disease. Systematic echocardiographic assessment requires comprehensive interrogation of coronary arteries using multiple imaging planes and must be performed by experienced practitioners given the operator-dependent nature of the technique. The case series presents three pediatric patients with giant coronary aneurysms as sequelae of Kawasaki disease, with specific documentation of clinical presentation and intervention.

Results

Three pediatric cases of giant coronary aneurysms secondary to Kawasaki disease are presented. One patient required coronary artery bypass grafting due to severe obstructive coronary lesions. The cases illustrate the natural history of giant coronary aneurysms, which characteristically evolve toward coronary thrombosis or resolution with severe obstructive lesions causing myocardial ischemia and acute myocardial infarction in the pediatric and adolescent populations.

Implications

Giant coronary aneurysms in Kawasaki disease carry a guarded prognosis with substantial risk for life-threatening complications including thrombotic events and progressive obstructive disease. Systematic echocardiographic screening and expert interpretation remain essential for risk stratification and clinical management decisions in affected pediatric populations. The presentation of a case requiring surgical revascularization underscores the necessity of aggressive monitoring and potential need for invasive interventions in severe coronary involvement.