Moritoh Yuji, Kamada Masahiro, Matsumoto Shinsaku, Kido Koji
Department of Pediatric Cardiology, Hiroshima Citizens Hospital, 7-33 Moto-machi, Hiroshima 730-8518, Japan.
Department of Anesthesiology, Hiroshima Citizens Hospital, 7-33 Moto-machi, Hiroshima 730-8518, Japan.
Eur Heart J Case Rep. 2021 Jun 7;5(6):ytab161. doi: 10.1093/ehjcr/ytab161. eCollection 2021 Jun.
Ruptured coronary artery aneurysm is rare, but the most serious complications of an acute phase of Kawasaki disease (KD) with giant coronary artery aneurysm (GCAA). Progressive or super GCAA, which rapidly dilates and continue to increase over a diameter of 10 mm, are more susceptible to rupture.
We report the case of a 6-year-old boy with KD who had multiple super GCAAs with a high risk of GCAA rupture. On admission to our hospital, he presented with fever, chest pain, and Stage II hypertension. Echocardiographic -scores adjusted for body surface area were used for measurements. The coronary artery diameter of segment 1 was 24.3 mm with a -score of 20.8; the diameter of segment 3 was 24.4 mm; the diameter of the left anterior descending branch was 32.6 mm with a -score of 20.1. The super GCAAs showed a tendency to expand compared to the latest echocardiography, and thrombus formation was observed in the super GCAA of segment 3. The patient was treated with anti-inflammatory therapy, antithrombotic therapy, and antihypertensive therapy with continuous arterial pressure monitoring with the goal of not exceeding the 5th percentile of the normal standard during the period when there was a risk of progressive coronary aneurysm expansion. He was discharged without any neurological complications.
We speculated that the patient's hypertension was the cause of an expanding coronary artery aneurysm. In conclusion, KD patients with super GCAA may benefit from aggressive blood pressure control with continuous arterial pressure monitoring.
冠状动脉瘤破裂罕见，但却是川崎病（KD）急性期合并巨大冠状动脉瘤（GCAA）最严重的并发症。进行性或超大GCAA，即迅速扩张并持续增大至直径超过10毫米者，更容易破裂。
我们报告了一名6岁KD男孩的病例，他患有多个超大GCAA，有很高的GCAA破裂风险。入院时，他表现出发热、胸痛和II期高血压。采用根据体表面积调整的超声心动图评分进行测量。1段冠状动脉直径为24.3毫米，评分为20.8；3段直径为24.4毫米；左前降支直径为32.6毫米，评分为20.1。与最新的超声心动图相比，超大GCAA有扩大趋势，且在3段超大GCAA中观察到血栓形成。对该患者进行了抗炎治疗、抗血栓治疗和降压治疗，并持续监测动脉压，目标是在冠状动脉瘤有进行性扩大风险的期间，动脉压不超过正常标准的第5百分位数。他出院时没有任何神经并发症。
我们推测患者的高血压是冠状动脉瘤扩大的原因。总之，患有超大GCAA的KD患者可能受益于通过持续监测动脉压进行积极的血压控制。
