Pathological study of sequelae of Kawasaki disease (MCLS). With special reference to the heart and coronary arterial lesions.

Unexpected sudden cardiac death among children with a history of Kawasaki disease has come to be reported in Japan. Death occurred between 2 months and 8 years after complete recovery from Kawasaki disease according to our study material. To study the lesions of Kawasaki disease sequelae we examined 61 cases of Kawasaki disease which came to autopsy. In 17 of these the deaths apparently to be due to sequelae of this disease, were characterized by cardiac insufficiency caused by ancient coronary aneurysm with organized thrombotic occlusion and superimposed acute ischemic myocardial degeneration and/or necrosis. The age of the lesions appears to correlate with the interval period between complete recovery from this disease and death. Six cases succumbed incidentally of other causes: one traffic accident, one hemophilus meningitis, one chronic myeloid leukemia, one neuroblastoma, one meningeal hemorrhage due to rupture of basilar arterial aneurysm, and one acute lymphatic leukemia. Even in these cases, definite sequelae of arteritis were detected. A surgically resected coronary aneurysm and a ventricular aneurysm were also examined. It was disclosed by mass physical check-up of school children that 0.1% had a history of Kawasaki disease, among which 5-6% showed cardiac and/or coronary abnormality including aneurysms. The high incidence of cardiac involvement in Kawasaki disease has been proved in this study and this kind of lesion has the possibility of resulting in unexpected cardiac death of children.