Document Detail


Ultrastructural characteristics of myocardial and coronary microvascular lesions in Kawasaki disease.
MedLine Citation:
PMID:  10388599     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Kawasaki disease (KD) is an acute febrile mucocutaneous lymph node syndrome with multisystemic vasculitis affecting mainly infants and children. Although several studies on cardiovascular lesions in KD have been done at the light microscopic level, the ultrastructural characteristics and incidences of these lesions have not been well defined. In order to investigate the myocardial and coronary microvascular sequelae in KD, we performed an ultrastructural study on endomyocardial biopsy specimens obtained during follow-up from 54 patients who had typical clinical manifestations of KD, of whom 47 had associated coronary aneurysms as demonstrated by coronary arteriography (CAG) or two-dimensional echocardiography in the acute or healed stage. The average age of onset was 2.2 years old and the duration of illness was from 2 months to 23 years. Follow-up CAG showed that the coronary aneurysms persisted in 33 of the 47 patients (8 with associated stenosis) and resolved in the remaining 14 patients. Ultrastructurally, the myocardial changes revealed hypertrophy, various degrees of degeneration, proliferation and abnormality of mitochondria, infiltration of a small number of lymphocytes, and fibrosis. The coronary microvascular lesion was characterized by microvascular dilatation, endothelial cell injury, platelet aggregation with thrombosis, and stenotic lumen with thickened walls in the small arterioles. It persisted after convalescent stage even up to 23 years and closely correlated with the myocardial sequelae. Moreover, significantly increased incidences of myocardial and coronary microvascular lesions were found in patients with coronary artery lesion. These findings suggest the coronary microvascular lesion as a possible underlying factor of persistent sequelae in KD.
Authors:
A M Liu; M Ghazizadeh; Z Onouchi; G Asano
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Microvascular research     Volume:  58     ISSN:  0026-2862     ISO Abbreviation:  Microvasc. Res.     Publication Date:  1999 Jul 
Date Detail:
Created Date:  1999-09-02     Completed Date:  1999-09-02     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0165035     Medline TA:  Microvasc Res     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  10-27     Citation Subset:  IM    
Copyright Information:
Copyright 1999 Academic Press.
Affiliation:
Central Institute for Electron Microscopic Researches, Nippon Medical School, Tokyo, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Age of Onset
Cardiomyopathy, Hypertrophic / etiology,  pathology
Child
Child, Preschool
Convalescence
Coronary Aneurysm / etiology,  pathology
Coronary Angiography
Coronary Disease / etiology,  pathology
Coronary Vessels / pathology,  ultrastructure*
Dilatation, Pathologic
Endocardium / ultrastructure*
Endomyocardial Fibrosis / etiology,  pathology
Female
Follow-Up Studies
Humans
Infant
Japan / epidemiology
Male
Mitochondria, Heart / ultrastructure
Mucocutaneous Lymph Node Syndrome / complications,  epidemiology,  pathology*
Myocarditis / etiology,  pathology

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