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Enrico Ammirati, Jane C. Burns, Antonella Moreo, Lori B. Daniels, Fabrizio Oliva, Extreme giant aneurysms of three coronary arteries causing heart failure as late sequelae of Kawasaki disease, European Heart Journal, Volume 38, Issue 10, 7 March 2017, Pages 759–760, https://doi.org/10.1093/eurheartj/ehw510
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A 59-year-old Filipino man without previous illness was admitted for heart failure (HF). Chest X-ray demonstrated an enlarged cardiac silhouette, with a prominent bulge on the third arch of the left heart border (Panel A). Echocardiography detected dilated cardiomyopathy with decreased left ventricular ejection fraction (LVEF 30%), and three large cystic aneurysmal structures: one at the level of the atrioventricular groove protruding inside the right atrium, and the other two in connection with the left main stem, located between the aorta and the pulmonary trunk (B; Supplementary material online, Video1). Cardiac magnetic resonance confirmed the presence of giant coronary artery aneurysms (GCAAs, maximum diameter of 63 mm in each vessel, C) with massive organized thrombosis (*) inside the right coronary artery (RCA) and the left circumflex artery (LCx). Coronary angiogram confirmed the diagnosis of GCAAs (D; Supplementary material online, Videos2,3). FDG-PET/CT of the chest and abdomen excluded an active vasculitis. A coronary angio-CT allowed to characterize the coronary aneurysms (E). The presence of proximal coronary aneurysms with coronary calcifications, Asian origin, in the absence coronary stenosis and without probable alternative diagnosis (i.e. Takayasu disease and Ehlers Danlos Type-IV) made the clinical picture attributable to presumed late sequelae of antecedent Kawasaki disease (KD), a self-limiting vasculitis, mainly affecting children younger than 5 years. Long-term antiplatelet therapy and warfarin were started together with HF medications. Cardiac surgery to exclude the aneurysms was deemed unfeasible. The patient was considered to be at an unpredictable risk of sudden death by coronary rupture or total occlusion, thus he was enlisted for heart transplantation. Figure labelling as follows: LAD: left anterior descending; RV: right ventricle; RA: right atrium; LA: left atrium; LV: left ventricle; DA: descending aorta; RPA: right pulmonary artery. !!...!!
