{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:29:10Z","timestamp":1762432150728,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,10,29]],"date-time":"2021-10-29T00:00:00Z","timestamp":1635465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Considerable advances have occurred in the understanding of Kawasaki disease, with a substantial drop in morbidity and mortality following the infusion of gamma globulin during the acute phase. Nevertheless, major complications may still occur. A 27-year-old male presented as an infant of 11 weeks when he was diagnosed as having Kawasaki disease. He was appropriately treated with aspirin and a gamma globulin infusion following his diagnosis 5 days after the onset of his illness. Despite that, he went on to develop coronary aneurysms. He represented a few weeks later with a history of inconsolable crying associated with pallor, suggestive of ischaemic chest pain. A repeat echocardiogram revealed infarction of the apex of the left ventricle with localised thrombus formation. There were persistent aneurysms within both coronary artery systems. A further infusion of gamma globulin was given. In view of the thrombus formation, he was started on warfarin. The thrombus gradually resolved with the development of a clearly defined left ventricular apical aneurysm. He has remained on warfarin, aiming for an international normalised ratio (INR) level of 2 to 2.5. He developed mild left ventricular dysfunction during late childhood, which improved following the commencement of an angiotensin-converting enzyme (ACE) inhibitor. Despite his ventricular aneurysm, there has been no documented evidence of ventricular tachycardia over the years. Repeated testing initially by nuclear perfusion scans and then by stress echocardiograms failed to show any inducible ischaemia apart from the apical ventricular aneurysm. A recent computed tomography (CT) coronary angiogram revealed an ectatic origin of the left main and the right coronary arteries with mild calcification involving the mid-portion of the latter and slight calcification of the former. His raised cholesterol level has responded well to a statin. Despite the persistence of the ventricular aneurysm, he continues to be managed conservatively, as he has remained well. The question arises as to what the long-term implications are of his left ventricle apical aneurysm. Should it be excised? Is he at risk for ventricular tachycardia and sudden death? In addition, although the coronary aneurysms have resolved, the CT coronary angiogram shows calcium plaques in both coronary arteries at the site of the earlier aneurysms. This finding raises the question as to whether all children who develop coronary artery aneurysms following Kawasaki disease should have a CT coronary angiogram performed in adulthood.<\/jats:p>","DOI":"10.3390\/children8110981","type":"journal-article","created":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T22:21:08Z","timestamp":1635805268000},"page":"981","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Major Complication Following Kawasaki Disease in an Infant\u2014The Development of Apical Infarction and Aneurysm Formation"],"prefix":"10.3390","volume":"8","author":[{"given":"Samuel","family":"Menahem","sequence":"first","affiliation":[{"name":"Melbourne Children\u2019s Cardiology\/Adult Congenital Heart, Melbourne, VIC 3161, Australia"},{"name":"Department of Paediatrics, Monash University, Melbourne, VIC 3800, Australia"},{"name":"Department of Paediatrics, University of Melbourne, Melbourne, VIC 3010, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Lefkovits","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia"},{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1016\/j.jacc.2015.12.073","article-title":"Kawasaki disease","volume":"67","author":"Newburger","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e927","DOI":"10.1161\/CIR.0000000000000484","article-title":"Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association","volume":"135","author":"McCrindle","year":"2017","journal-title":"Circulation"},{"key":"ref_3","first-page":"21","article-title":"Mucocutaneous lymph node disease in childhood","volume":"12","author":"Spensley","year":"1976","journal-title":"Aust. Paediatr. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1056\/NEJM199106063242305","article-title":"A Single Intravenous Infusion of Gamma Globulin as Compared with Four Infusions in the Treatment of Acute Kawasaki Syndrome","volume":"324","author":"Newburger","year":"1991","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1017\/S1047951100006922","article-title":"Serious sequels of Kawasaki Disease","volume":"8","author":"Kim","year":"1998","journal-title":"Cardiol. Young"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1111\/j.1440-1754.2009.01531.x","article-title":"Do Kawasaki disease patients without coronary artery abnormalities need a long-term follow-up? A myocardial single-photon emission computed tomography pilot study","volume":"45","author":"Zanon","year":"2009","journal-title":"J. Paediatr. Child. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1161\/01.CIR.91.1.122","article-title":"Feasibility of Exercise Stress Echocardiography for the Follow-up of Children With Coronary Involvement Secondary to Kawasaki Disease","volume":"91","author":"Pahl","year":"1995","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3384","DOI":"10.1161\/01.CIR.96.10.3384","article-title":"Silent myocardial ischemia in Kawasaki disease: Evaluation of percutaneous transluminal coronary angioplasty by dobutamine stress testing","volume":"96","author":"Ogawa","year":"1997","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.clinimag.2008.09.008","article-title":"Coronary artery noninvasive imaging in adult Kawasaki disease","volume":"33","author":"Cantin","year":"2009","journal-title":"Clin. Imaging"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jcmg.2011.12.010","article-title":"Calcium Scoring in Patients with a History of Kawasaki Disease","volume":"5","author":"Kahn","year":"2012","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/j.1365-2249.2011.04331.x","article-title":"The role of atorvastatin in regulating the immune response leading to vascular damage in a model of Kawasaki disease","volume":"164","author":"Blankier","year":"2011","journal-title":"Clin. Exp. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1161\/01.CIR.94.6.1379","article-title":"Long-term consequences of Kawasaki disease: A 10- to 21-year follow-up study of 594 patients","volume":"94","author":"Kato","year":"1996","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF02279876","article-title":"Myocardial ischemia in Kawasaki disease: Follow-up study by cardiac catheterization and coronary angiography","volume":"9","author":"Suzuki","year":"1988","journal-title":"Pediatr. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/S0022-3476(97)70038-6","article-title":"Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin dose but independent of salicylate dose","volume":"131","author":"Terai","year":"1997","journal-title":"J. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1111\/ped.12733","article-title":"Recurrent Kawasaki disease: USA and Japan","volume":"57","author":"Maddox","year":"2015","journal-title":"Pediatr. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1007\/s00246-009-9599-7","article-title":"Improved classification of coronary artery abnormalities based only on cor-onary artery z-scores after Kawasaki disease","volume":"31","author":"Manlhiot","year":"2009","journal-title":"Pediatr Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.hlc.2008.01.003","article-title":"Giant Coronary Artery Aneurysms in Kawasaki Disease\u2014The Need for Coronary Artery Bypass","volume":"17","author":"Yeu","year":"2008","journal-title":"Hear. Lung Circ."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.ppedcard.2004.08.007","article-title":"Cardiovascular complications in Kawasaki disease: Coronary artery lumen and long-term consequences","volume":"19","author":"Kato","year":"2004","journal-title":"Prog. Pediatr. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2710","DOI":"10.1161\/CIRCULATIONAHA.106.179568","article-title":"Cardiovascular risk reduction in high-risk pediatric patients: A scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research","volume":"114","author":"Kavey","year":"2006","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.kjms.2014.12.001","article-title":"Diagnostic value of contrast-enhanced ultrasound in thyroid nodules with calcification","volume":"31","author":"Jiang","year":"2015","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_21","first-page":"614","article-title":"Left ventricular aneurysm in a 4-year-old boy","volume":"32","author":"Ercan","year":"2005","journal-title":"Tex. Hear. Inst. J."},{"key":"ref_22","first-page":"479","article-title":"Malignant ventricular arrhythmia in congenital aneurysms of the left ventricle in adulthood","volume":"58","author":"Meyer","year":"1992","journal-title":"Helvetica Chir. Acta"},{"key":"ref_23","first-page":"35","article-title":"Management of the congenital aneurysm of the left ventricle as-sociated with mitral insufficiency in a child: A case report","volume":"5","author":"Mitsomoy","year":"2013","journal-title":"J. Cardiovac. Thoarc. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.1016\/j.athoracsur.2009.03.094","article-title":"Left Ventricular Aneurysm in a Child with Severe Combined Immunodeficiency Syndrome","volume":"88","author":"Jamshidi","year":"2009","journal-title":"Ann. Thorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.1016\/j.jacc.2012.11.019","article-title":"2013 ACCF\/AHA Guideline for the Man-agement of ST-Elevation Myocardial Infarction","volume":"61","author":"Kushner","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1007\/s00246-010-9838-y","article-title":"The 30-Year Outcome for Patients After Myocardial Infarction Due to Coronary Artery Lesions Caused by Kawasaki Disease","volume":"32","author":"Tsuda","year":"2010","journal-title":"Pediatr. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1177\/0300060518800127","article-title":"Treatment outcomes and therapeutic evaluations of patients with left ven-tricular aneurysm","volume":"47","author":"Sui","year":"2019","journal-title":"J. Int. Med. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1017\/S1047951105001344","article-title":"Changes in causes of sudden deaths by decade in patients with coronary arterial lesions due to Kawasaki disease","volume":"15","author":"Tsuda","year":"2005","journal-title":"Cardiol. Young"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/11\/981\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:22:54Z","timestamp":1760167374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/11\/981"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,29]]},"references-count":29,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["children8110981"],"URL":"https:\/\/doi.org\/10.3390\/children8110981","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2021,10,29]]}}}