Percutaneous Transluminal Coronary Angioplasty for Coronary Artery Stenosis in a Young Patient with Long Term Kawasaki Disease
A 14-year-old boy was admitted to our institution for elective PTCA to relieve stenosis of the coronary arteries. At 4 years and 7 months of age, the patient presented to our institution with typical signs and symptoms of KD (persistent fever up to 39℃ for 10 days accompanied with conjunctival injection and a strawberry tongue). Consequently, the patient received intravenous gamma globulin and aspirin, which resulted in a prompt resolution of the fever and improvement of symptoms. Two-dimensional echocardiography performed during the acute phase of the illness demonstrated fusiform aneurysms of the right coronary artery (RCA) (10 mm in diameter), left anterior descending (LAD) branch (7 mm), and left circumflex (3.7 mm), as well as dilatation of the left main coronary artery (LMCA) (4 mm). However, there was normal systolic ventricular function without regional wall motion abnormalities. The patient was given low-dose aspirin and discharged from the institution. After discharge the patient was free of symptoms. An echocardiogram performed 15 months after the onset of illness demonstrated mildly improved fusiform aneurysms of the RCA (8.4 mm) and LAD (5 mm), as well as improved dilatation of LMCA (3.4 mm). However, there was no change in the left circumflex lesion. The patient was continued on a therapy of low-dose aspirin and remained asymptomatic. A 24 hour Holter monitor at 20 months, 40 months, and 68 months after presentation indicated normal heart rhythm with no evidence of ischemia. A treadmill test performed 9 years after presentation revealed no arrhythmias or ischemic changes. Nine years and 5 months after disease onset, selective coronary angiography revealed two saccular aneurysms in the proximal portion of the LAD, and in the proximal portion of the RCA as well as stenosis (minimal lesion in the proximal portion of the LAD, discrete lesion in the left circumflex, and total obstruction in the RCA with collateral arteries supplying blood to the distal portion of the RCA.)(). The patient retrospectively reported symptoms of intermittent chest discomfort for 5 months prior to catheterization. On admission, his blood pressure was 120/80 mmHg. His heart rhythm was regular and his heart rate was 76 bpm. The patient looked well and his physical examination and laboratory results did not reveal any abnormalities. Accordingly PTCA was performed at 9 years and 6 months after the onset of illness. The procedure employed a 3.5 mm balloon catheter in the stenotic lesion of the proximal portion of the left circumflex. The balloon was then inflated with diluted contrast medium to a pressure of 10 atm. The area of stenosis was 80% before PTCA and there was no residual stenosis after PTCA (). An intravascular ultrasound (IVUS) study was performed immediately after PTCA. The IVUS imaging revealed a calcified lesion and atheroma at the site of the left circumflex coronary artery (). The patient tolerated the procedure well with no electrocardiographic changes. He was discharged home on aspirin, ticlopidine, and isosorbide dinitrate. To date, he has been well. Currently, the patient is following a regimen of low-dose aspirin.