Page 23 - Journal of Structural Heart Disease Volume 2, Issue 5

Case Report
Journal of Structural Heart Disease, October 2016, Volume 2, Issue 5:224-230
DOI: http://dx.doi.org/10.12945/j.jshd.2016.011.15
Received: November 01, 2015 Accepted: January 28, 2016 Published online: October 2016
Successful Revascularization of a Completely Occluded Right Coronary Artery by Local Thrombus Fragmentation, Thrombolysis, Thrombus Aspiration, and Balloon Angioplasty in a Patient with Atypical Kawasaki Disease
A Case Report and Review of the Literature
Zora Meyer, MD1, Kai Thorsten Laser, MD, PhD1, Sissi Bach, MD1, Carola Hesse, MD1, Deniz Kececio- glu, MD, PhD1, Werner Scholtz, MD2, Christoph M. Happel, MD, PhD1, Nikolaus A. Haas, MD, PhD1,3*
1 Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
2 Department for Cardiology, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany 3 Department for Pediatric Cardiology and Intensive Care, Ludwig Maximilians University Munich, Muenchen, Germany
Abstract
Background: The clinical presentation of atypical Kawa- saki disease (KD) is variable; thus, an accurate diagno- sis may be missed. With intravenous immunoglobulin therapy, the risk of coronary arterial lesions has been reduced from 20–25% to about 5%. Coronary artery aneurysms may remain clinically silent, but thrombosis may result in acute myocardial infarction. We report a case with complete occlusion of the right coronary artery (RCA) due to thrombosis of large aneurysms and severe stenoses after atypical KD.
Methods: A 10-year-old boy was admitted to our terti- ary medical center after two episodes of ventricular brillation caused by acute myocardial infarction. Results: Coronary angiography showed aneurysms of the left coronary artery and a completely occluded RCA. Transcatheter revascularization was achieved by a combination of mechanical thrombus fragmentation, intracoronary thrombolysis, thrombus aspiration, and balloon angioplasty of two stenosed areas of the RCA,
resulting in complete reperfusion. The child´s past medical history revealed the diagnosis of untreated atypical KD 6 months previously.
Conclusions: There are few reports of coronary inter- ventions after KD in young patients. Coronary artery abnormalities include persistent aneurysms with the risk of thrombosis and progressive stenosis. However, no con rmed treatment guidelines exist for this partic- ular patient group. Based on the highly variable anat- omy of the coronary arteries, an individualized therapy using the full armamentarium of endovascular treat- ments may be necessary. This case study suggests that primary percutaneous coronary intervention using a targeted approach might be safe and e ective in the treatment of acute myocardial infarction after KD. Copyright © 2016 Science International Corp.
Key Words
Atypical • Kawasaki disease • Coronary occlusion • Intracoronary lysis • Pediatrics interventions
* Corresponding Author:
Nikolaus A Haas, MD, PhD
Department for Pediatric Cardiology and Intensive Care
Ludwig Maximilians University
Marchioninistrasse 15, 81377 Muenchen, Germany
Tel.: +49 89 4400 73941; Fax: +49 89-4400-73943; E-Mail: Nikolaus.Haas@med.uni-muenchen.de
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2016 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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