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Kawasaki's disease: morphology of coronary artery aneurysms.

Sir, The aetiology of Kawasaki’s disease (KD) remains unknown, although bacterial toxins and autoimmunity may be involved in its pathogenesis. Cardiac sequelae from KD involvement are the most important manifestations of KD, and coronary artery abnormalities include ectasia, non-giant and giant aneurysms, with ventricular dysfunction. We describe a case of coronary aneurysms and acute myocardial infarction as a consequence of Kawasaki’s disease in a 29-year-old female. The patient was referred to our hospital one hour after the onset of symptoms of acute myocardial infarction. Abnormal Q waves appeared on electrocardiograph (ECG). The patient had no history of coronary artery disease and she had been well until just before the myocardial infarction. Coronary angiography showed multiple proximal obstructions and aneurysmal dilations of the left main (LMCA) and right coronary arteries (RCA). A balloon angioplasty was performed as a life saving procedure. Cardiogenic shock developed after the surgical procedure of myocardial revascularisation and one day after admission the patient underwent heart transplantation. At present, the patient is alive and in good clinical condition. On gross examination, the explanted heart showed multiple coronary aneurysms involving LMCA and RCA (Fig. 1, 2) complicated by thrombosis of the LMCA aneurysm and massive myocardial infarction (Fig. 3). No atherosclerotic change was noted and the coronary ostia were found to be patent and in normal position.