SEQUELAE OF KAWASAKI-DISEASE IN ADOLESCENTS AND YOUNG-ADULTS

Kawasaki disease is an acute vasculitis of unknown etiology that predo minantly affects children <5 years of age. Structural damage to the co ronary arteries after the acute, self-limited illness is detected by e chocardiography in similar to 25% of untreated patients, The long-term effects of the acute coronary arteritis are unknown. To define the sp ectrum of clinical disease in young adults that can be attributed to K awasaki disease in childhood, we performed a retrospective survey of c ases reported in the English and Japanese published data of adult coro nary artery disease attributed to antecedent Kawasaki disease. The mea n age at presentation with cardiac sequelae was 24.7 +/- 8.4 years (ra nge 12 to 39) for the 74 patients identified with presumed late sequel ae of Kawasaki disease. Symptoms at the time of presentation with card iac sequelae included chest pain/myocardial infarction (60.8%), arrhyt hmia (10.8%) and sudden death (16.2%). These symptoms were precipitate d by exercise in 82% of patients. One-third of the patients in whom a chest radiograph was taken had ring calcification, Angiographic findin gs included coronary artery aneurysm (93.2%) and coronary artery occlu sion (66.1%). Extensive development of collateral vessels was reported in 44.1% of patients, Autopsy findings included coronary artery aneur ysms (100%) and coronary artery occlusion (72.2%). The acute vasculiti s of Kawasaki disease can result in coronary artery damage and theolog ic changes predisposing to thrombus formation or progressive atheroscl erotic changes that may remain clinically silent for many years, Coron ary artery aneurysms and calcification on chest radiography were unusu al features in this group of patients. A history of antecedent Kawasak i disease should be sought in all young adults who present with acute myocardial infarction or sudden death.