Page 28 - Journal of Structural Heart Disease Volume 2, Issue 5

229
Case Report
case series of 23 stenotic lesions in 22 patients (aged 2 to 24 years) where a total of 21 lesions (91%) could be treated successfully by PTCA, PTCRA, and stent im- plantation. In general, localized stenosis of the coro- nary arteries can be treated by balloon angioplasty, and in those patients with severe calci cation, PTCRA is the treatment of choice with good short-term results [16–19]. Drossner et al. [20] reported a 3-year- old girl with acute myocardial infarction and large left and RCA aneurysms who had been diagnosed with KD at 4 months of age. Successful coronary revascu- larization was performed by balloon angioplasty and placement of two stents. Dahdah et al. [21] reported an 11 1⁄2-year-old girl in whom successful recanaliza- tion was achieved using a high-frequency mechani- cal vibration catheter (Crosser catheter); additional balloon dilatation was performed and a stent was de- ployed. Finally, Parsa et al. [7] reported a 35-year-old man with acute myocardial infarction after a history of KD at the age of 5 years. The patient underwent thrombectomy and a stent was deployed. Grade III ow was established.
Rarely, covered stents may be needed to cover large aneurysms prone to intracoronary thrombus formation. Waki et al. [22] reported satisfactory long- term outcome for transcatheter polytetra uoroeth- ylene-covered stent implantation in a giant CAAs with a 90% stenosis.
In our case, we used a combination of the treat- ment modalities outlined above. First, mechanical thrombus fragmentation was performed, and direct intracoronary thrombolysis using high doses of rT-PA supported delineation of the vessel. Thrombus aspiration thereafter, in combination with additional
local thrombolysis, outlined the exact anatomy of the RCA with large aneurysms and two severe stenoses, so that nally recanalization and complete reperfu- sion of the occluded RCA could be achieved by a combination of thrombectomy, intracoronary throm- bolysis, and additional balloon angioplasty. PTCRA and DCA were not necessary due to the apparent lack of calci cation.
Conclusions
Based on our experience and the literature presented, percutaneous coronary intervention is a safe and effective short-term treatment for chil- dren with acute myocardial infarction due to coro- nary sequelae of KD. The combination of various techniques may be necessary to address the differ- ent coronary pathologies as outlined in our case report.
Acknowledgments
This study was supported by hospital funding.
Con ict of Interest
The authors have no con icts of interest relevant to this publication.
Comment on this Article or Ask a Question
References
1. Burns JC, Glodé MP. Kawasaki syndrome. Lancet. 2004;364:533-544. DOI: 10. 4. 1016/S0140-6736(04)16814-1
186.DOI:10.1067/mpd.2000.107164 Ariyoshi M, Shiraishi J, Kimura M, Mat- sui A, Takeda M, Arihara M, et al. Primary percutaneous coronary intervention for acute myocardial infarction due to pos- sible sequelae of Kawasaki disease in young adults: a case series. Heart Ves. 2011;26:117-124. DOI: 10.1007/s00380- 010-0051-y
Kato H, Sugimura T, Akagi T, Sato N, Hash- ino K, Maeno Y, et al. Long-term conse- quences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients.
Circulation. 1996;94:1379-1385. DOI:
10.1161/01.CIR.94.6.1379
6. Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE Jr, Burke JA, et al. ACCF/ AHA/SCAI 2013 update of the clinical competence statement on coronary ar- tery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/ American College of Physicians Task Force on Clinical Competence and Training (writing committee to revise the 2007 clinical competence statement on car-
2. Jang GY, Kang IS, Choi JY, Bae EJ, Kim YH, Kim SH, et al. Nationwide survey of cor- onary aneurysms with diameter >6mm in Kawasaki disease in Korea. Pediatr Int. 2014;57:367-372. DOI: 10.1111/ped.12536
3. Akagi T, Ogawa S, Ino T, Iwasa M, Echigo S, Kishida K, et al. Catheter interventional treat- ment in Kawasaki disease: a report from the Japanese Pediatric Interventional Cardiology Investigation group. J Pediatr. 2000;137:181-
5.
Meyer, Z. et al.
Revascularization after Atypical Kawasaki Disease