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The vasculitis of Kawasaki disease (KD) causes coronary aneurysms in about 10% of patients early after the onset. 1 Aneurysms usually change their shape after the acute phase, but some may persist for years whereas others either regress or evolve into stenotic lesions. 2- 4 Usually, the diameters of persistent aneurysms may increase slightly because of somatic growth or they may decrease because of intimal thickening of the vascular wall. 5- 8 In the late period of KD either new aneurysms or expanding aneurysms are unusual but have been reported. 9- 12 We investigated the characteristics of the dilated lesions and their time of appearance and speculate about their cause.
PATIENTS AND METHODS
Between 1978 and 2003, after giving informed consent, 562 patients with coronary arterial lesions underwent selective coronary angiography on at least two occasions. The protocol was as follows. Coronary angiography for patients with coronary arterial lesions was performed immediately after the acute phase of KD. All patients underwent a second coronary angiography after one year and subsequent follow up coronary angiography was done at 3-5 year intervals depending on the findings. If the aneurysms regressed, subsequent coronary angiography was not done but the patients were followed up in the outpatient clinic by non-invasive imaging including echocardiography and electron beam computed tomography. If coronary arterial lesions were suspected on non-invasive imaging, coronary angiography was considered at that time. Some patients who attended our hospital late after the acute KD episode were also included. Those patients did not undergo coronary angiography immediately after the acute phase.
RESULTS
We found 17 lesions in 15 patients that were coronary dilatations developing late after KD (3%, 11 boys, four girls). All 15 had received anticoagulant treatment. Eight patients underwent coronary artery bypass grafting (CABG), and one patient underwent percutaneous balloon angioplasty. Late coronary artery dilatations after KD can be divided into two groups: new aneurysms and expanding aneurysms.
New aneurysms
We found 15 new aneurysms in 13 patients in the coronary arteries as follows: right coronary artery (RCA), three; left anterior descending coronary artery (LAD), eight; left circumflex artery, three; and left main trunk, one. Fourteen of 15 new aneurysms were in the proximal vessel segments. In 10 lesions, there had been a pre-existing aneurysm at the...