As research on Kawasaki disease continues to progress, there is a greater understanding of the cardiac sequelae of Kawasaki disease. The prognosis is good if there are no sequelae in the acute phase or if there is a transient coronary artery dilatation without new lesions in the recovery period. On the other hand, if a moderate or higher coronary aneurysm is present in the acute phase, the risk of evolution to an occlusive lesion can be presumed based on the size, morphology, and presence of the tumor. There is now a unanimous acceptance regarding this approach. Based on these aspects of understanding, this management criteria was developed with clinicians in mind, after observation of the course of the disease in preschool children and older children, and includes criteria for exercise management. Clinicians are expected to refer to this criterion for management.
1. No coronary artery aneurysm
(Within 1 month after the onset of the disease, echocardiographic examination of the acute phase without dilated coronary artery lesions, only the increase in coronary artery radiance is not meaningful, and echocardiographic examination of those whose acute phase symptoms have been prolonged for more than 2 weeks is based on the disappearance of acute phase symptoms after 2 weeks)
(1) Observation: review at 1 month, (6 months), 1 year and 5 years after onset, and subsequent follow-up according to the agreement of the competent physician and guardian.
(2) Examination: Echocardiography at 1 month, 1 year and later if necessary after onset
(3) Exercise restriction: not necessary.
(4) Treatment: no need to continue treatment after the symptoms disappear in the acute phase.
2. Transient coronary artery dilation
Lesion: those who have been normal at the onset of the disease for one month, according to the standard 1 after observation: according to the standard 1
Examination: in accordance with criterion 1.
Exercise restriction: not necessary.
Treatment: no need to continue treatment after the disappearance of symptoms in the acute phase
3. Coronary artery aneurysm that had been present at one month of onset
(lesions of 4, 5, 6) have spontaneously resolved during the course of the disease (no residual dilated lesions are seen in all coronary regions by echocardiography and coronary angiography) and no further lesions after (4) appear after this time
After observation: follow-up until the disappearance of the coronary aneurysm during the drug administration and annually thereafter. The size, morphology, and presence of coronary aneurysm at 1 month of onset should be observed for comparison at subsequent follow-ups
Examination: Echocardiography is appropriate for one month of onset until the disappearance of the aneurysm and later as needed, and coronary angiography should be performed selectively for those with residual lesions in (4)
Exercise restriction: not necessary.
Treatment: application of antithrombotic therapy until the aneurysm is confirmed to have disappeared after the acute phase, and no need to continue treatment thereafter.
4. Mild dilatation of coronary arteries at one month of onset (ANs or Dil)
Limited dilatation of the aneurysm with an internal diameter of 4 mm or less, less than 1.5 times the internal diameter of the peripheral coronary artery in older children over 5 years of ageu After observation: during antithrombotic therapy and annually thereafter
Examination: echocardiography during the acute phase as appropriate, and selective coronary angiography from one month to one year after onset and as early as possible (within one year). Regular ECG and echocardiography at least once a year thereafter, with repeat selective coronary angiography as determined by the pediatric cardiologist
Exercise restriction: not necessary
Treatment: Apply antithrombotic therapy until the coronary lesion is stable, and later at the discretion of the competent physician
5. moderate size aneurysm (ANm) in coronary artery at one month of onset
The internal diameter of the aneurysm is greater than 4 mm and less than 8 mm, 1.5 to 4 times the internal diameter of the peripheral coronary artery in older children over 5 years oldu .
After observation: observation and management according to the judgment of the pediatric cardiologist and during post-discharge pharmacological antithrombotic therapy (roughly one month).
Examination: electrocardiogram and echocardiogram as appropriate. First coronary angiogram as soon as possible after resolution of symptoms in the acute phase. Appropriate ECG and echocardiogram review later. Selective arteriography and myocardial isotopes are performed regularly according to the judgment of the pediatric cardiologist. In particular, aneurysmal dilatation and string-like tumors in the anterior descending branches emanating from the left coronary artery trunk should be carefully monitored.
Exercise restriction: Occupational exercise programs are prohibited according to the judgment of the pediatric cardiologist
Treatment: Continuous application of antithrombotic therapy is recommended according to the judgment of the competent physician.
6. Huge aneurysm in the coronary artery at one month of onset (ANI)
The inner diameter of the aneurysm exceeds 8 mm, and is greater than 4 times the inner diameter of the peripheral coronary artery in older children over 5 years of age
After observation: It is essential to be followed by a pediatric cardiologist, to give antithrombotic therapy and to observe closely from the time of thrombosis in the aneurysm to the 3-month risk period when myocardial infarction is most likely to occur. During this period, it is very important to apply echocardiography to observe the presence of intra-aneurysmal thrombosis and electrocardiography to determine myocardial ischemia. After discharge from the hospital, during the drug treatment (roughly monthly review)
Examination: first coronary angiography as soon as possible after the disappearance of symptoms in the acute phase. Regular selective arteriography and myocardial isotope examination to observe myocardial ischemia according to the judgment of the pediatric cardiologist
Treatment: prudent and continuous application of antithrombotic therapy is recommended according to the judgment of the competent physician
Exercise restriction: Occupational exercise program is prohibited according to the judgment of the pediatric cardiologist, and the amount of distant exercise is appropriately controlled.
7. Those with coronary stenotic lesions and myocardial ischemic lesions are subject to giant coronary aneurysms, which should be corresponded to with more caution compared with (6).
8.Other
Vascular lesions other than coronary arteries accompanied by at least coronary artery lesions as a basis.
Management of aortic and mitral valve insufficiency after the acute phase of valvular lesions according to the severity, corresponding according to the judgment of pediatric cardiologists, with transient pericarditis (pericardial effusion), tricuspid valve insufficiency, and mitral valve insufficiency should focus on transient coronary lesions as the basis.
Rare cases of dilated cardiomyopathy-like symptoms caused by myocardial damage have different management criteria according to the degree of impact on cardiac function, which is determined by the judgment of the pediatric cardiologist.