CARDIAC FOLLOW UP OF PATIENTS WITH KAWASAKI DISEASE Maria Ina de la Paz – Bunyi, MD Section Chief, PediaCaRe & Ambulatory Section Philippine Heart Center Asst. Chief, Kidney, Heart & Lung Centre Philippine Children’s Medical Center Kawasaki Disease: Cardiac Manifestations The Heart of the Matter Is The Matter of the Heart ipbunyi.pidsp2016 OBJECTIVES 1. To discuss the indications for doing 2-D Echo in a patient with Kawasaki Disease and how often should it be done. 2. If a patient is allergic to aspirin, to discuss other alternative drugs. 3. To discuss the duration of treatment, with or without aneurysm. ipbunyi.pidsp2016 Cardiovascular manifestations of KD (in order of frequency) Duarte et al: • Myocarditis (50-70%) • Pericarditis with pericardial effusion (25%) • Coronary artery aneurysms (15-25%, untreated) • Systemic arterial aneurysms (2%) • Valvular disease (esp. MR sec. rupture of chordae leading to papillary m dysfunction) • Mild aortic root dilatation (acute phase) • Myocardial infarct (1%) Insights Imaging. 2010 Sep; 1(4): 223–231. Published online 2010 Jul 30 ipbunyi.pidsp2016 KAWASAKI DISEASE: CARDIAC INVOLVEMENT Manifestations of cardiac involvement • Acute • Sub-acute phase • Chronic Phase ipbunyi.pidsp2016 CARDIOVASCULAR CHANGES Acute and Sub-acute Phase PANCARDITIS CORONARY ARTERY ABNORMALITIES •Mitral regurgitation •Tricuspid regurgitation • Perivascular inflammation •Aortic regurgitation • Ectasia •Myocardial dysfunction • Aneurysm •Pericardial effusion ipbunyi.pidsp2016 CARDIOVASCULAR CHANGES Chronic Phase CORONARY ARTERY ABNOMALITIES/ SEQUELAE – Coronary artery insufficiency – Regional and global dysfunction – Ischemia related atrioventricular valve dysfunction – Coronary artery stenosis – Chronic fibrosis and thickening – Thrombus formation ipbunyi.pidsp2016 Kawasaki Disease in RP 1987 - The first documented coronary aneurysm – 5 year old boy with KD ipbunyi.pidsp2016 Kawasaki Disease in RP ipbunyi.pidsp2016