LONG-TERM FOLLOW-UP OF PATIENTS WITH KAWASAKI-DISEASE

Cardiac sequelae of Kawasaki syndrome may range from no detectable' ab normalities to giant aneurysms with thrombosis or stenosis. The issues often debated in long-term follow-up include interval and intensity o f evaluations, type of diagnostic tests to be used, choice of drugs an d indications for medical and surgical interventions directed toward c oronary artery problems. Although echocardiography is a powerful tool in the early follow-up, its utility is diminished during the chronic p hase. Although the value of coronary angiography is undisputed, its us e should be limited to the patients with large or complex aneurysms. R epeat angiography should be guided for the most part by appearance or worsening of ischemic changes by non-invasive studies. Despite normal angiographic appearance of the coronary artery following regression, r ecent evidences from vasoactivity studies, intravascular ultrasound, a nd biochemical data suggest long-term abnormalities in vascular endoth elium. Stress ECG lacks in sensitivity and specificity. Stress echocar diography with exercise or dobutamine may be an acceptable alternative , but its performance is subject to the 'learning curve.' Myocardial s cintigraphy has been shown to be sensitive in detecting ischemia. Howe ver, its specificity in Kawasaki syndrome is still debatable. Recent ' high-tech' diagnostic tests have limitations in clinical applicability . Regarding therapy, our midterm experience with the combined use of l ow-dose warfarin and low-dose aspirin in patients with giant aneurysms suggests its efficacy in preventing coronary thrombosis. Thrombolytic therapy for acute infarction or coronary thrombosis appears safe and effective. The role of coronary balloon angioplasty in the management of Kawasaki syndrome is uncertain. Controversies surround the indicati ons for coronary artery bypass graft surgery in Kawasaki syndrome. Dec ision for surgery seems justified in an asymptomatic child when eviden ce points to a large myocardial segment in jeopardy since a high morta lity rate and lack of prior warning are characteristic of myocardial i nfarction due to Kawasaki disease. (C) 1997 Elsevier Science Ireland L td.