Gordon John B, Burns Jane C
San Diego Cardiac Center and Sharp Memorial Hospital, San Diego, CA, USA.
Dept of Pediatrics, University of California San Diego, and Rady Children's Hospital, San Diego, CA, USA.
Glob Cardiol Sci Pract. 2017 Oct 31;2017(3):e201731. doi: 10.21542/gcsp.2017.31.
A growing population of young adults is presenting to cardiologists with late manifestations of Kawasaki disease (KD) that include cardiomyopathy, ischemia, and infarction. The management of these conditions differs in important ways from atherosclerotic heart disease, and yet there is little awareness in the adult cardiology community regarding the special challenges posed by the cardiovascular sequelae of KD. Observations were made on a population of 140 adult KD patients enrolled in the San Diego Adult KD Collaborative Study. Coronary artery aneurysms resulting from KD in childhood are associated with a high risk of thrombosis and stenosis at the inlet or outlet of the aneurysm. These aneurysms are often highly calcified and may contain a large thrombus burden that may obscure the true size of the aneurysm. Pitfalls in the management of these patients stem largely from failure to recognize the nature of the lesions, which leads to attempts to dilate highly calcified stenotic segments and undersizing of stents. Intravascular ultrasound is helpful in appreciating the true dimensions of the aneurysm, which may be filled with thrombus. Thrombolysis and use of anti-platelet agents followed by systemic anti-coagulation are appropriate management strategies for patients presenting with acute infarction. Bypass grafting with the internal thoracic arteries can be a successful strategy, but care must be taken to avoid competitive flow through the native vessel leading to graft failure. In contrast to the individuals who developed coronary artery aneurysms, young adults who had documented normal echocardiograms associated with their acute KD in childhood and who have no evidence of calcium deposition in the arterial wall as assessed by computed tomography (CT) calcium score appear to have no increased cardiovascular risk in the medium term. Long-term outcomes for adults post-KD in childhood are still being defined. KD poses special management challenges for the adult cardiologist who must recognize the unique features of the cardiovascular lesions in this growing population of patients.
越来越多的年轻成年人因川崎病（KD）的晚期表现（包括心肌病、缺血和梗死）而前来心内科就诊。这些病症的治疗在重要方面与动脉粥样硬化性心脏病不同，然而，成人心脏病学界对KD心血管后遗症带来的特殊挑战几乎没有认识。对参与圣地亚哥成人KD协作研究的140例成年KD患者进行了观察。儿童时期KD导致的冠状动脉瘤与瘤体入口或出口处血栓形成和狭窄的高风险相关。这些动脉瘤通常钙化严重，可能含有大量血栓负荷，这可能会掩盖动脉瘤的真实大小。这些患者治疗中的陷阱主要源于未能认识到病变的性质，这导致试图扩张高度钙化的狭窄节段以及支架尺寸过小。血管内超声有助于了解可能充满血栓的动脉瘤的真实尺寸。对于出现急性梗死的患者，溶栓和使用抗血小板药物后进行全身抗凝是合适的治疗策略。使用胸廓内动脉进行搭桥手术可能是一种成功的策略，但必须注意避免通过天然血管的竞争性血流导致移植失败。与发生冠状动脉瘤的个体不同，童年急性KD时超声心动图记录正常且计算机断层扫描（CT）钙评分评估显示动脉壁无钙沉积证据的年轻成年人，在中期似乎没有增加的心血管风险。儿童期患KD后的成年人的长期预后仍在确定中。KD给成年心脏病专家带来了特殊的治疗挑战，他们必须认识到这一不断增加的患者群体中心血管病变的独特特征。
