ABSTRACT
During a nine year period, two-dimensional echocardiography was used to evaluate the coronary artery lesions in 293 patients with Kawasaki disease. There were 170 males and 123 females (M: F = 1.4:1), with a mean age of 28.5 months (2 months-10 years). Patients were randomly divided into 3 groups according to different treatment regimens: group A, aspirin 60-80 mg/kg alone, 199 patient; group B, aspirin plus intravenous gamma globulin (IVGG) 400 mg/kg for 5 days, 80 patients; group C, aspirin plus a single dose of IVGG 2.0 gm/kg, 14 patients. A total of 106 patients (36.2%) had coronary artery lesions. The prevalence of coronary artery lesions in groups A, B, and C was 42.7%, 22.5% and 21.4% respectively. It was the highest in group A (P < 0.01). Coronary artery involvement occurred with equal frequency in males and females. There was a significantly greater incidence of coronary artery lessons in infants younger than 1 year of age than in older children (P < 0.05). From the serial echocardiographic studies, the coronary artery lesions occurred earliest on the 5th day of onset, with the prevalence of 23.6% in the acute stage, and 35.4% at the subacute stage. The prevalence of coronary artery abnormalities in group A was significantly higher than in group B and C at 2-3 weeks and 7-8 weeks after the onset of the fever (P < 0.01). Coronary artery lesions were further classified into 3 morphologic types: dilated form, fusiform and saccular aneurysm. The prevalence of saccular aneurysms was higher in group A than in group B and C (10.0% vs 1.2%, 0%, P < 0.01). Moreover, the regression rate was also higher in group A than the other groups (P < 0.01). Fifteen cineangiograms were performed on 14 patients and they confirmed the presence of coronary lesions in all cases. Better visualization of the lesions was achieved by cineangiography than by echocardiography, especially in the middle and distal portions of the coronary artery. In group A, a six months old boy expired, 25 days after suffering from fever, due to myocardial infarction and congestive heart failure, which was also confirmed by a postmortem examination. It appears that gamma globulin infusion especially a single high dose regimen, is more effective than the conventional aspirin therapy for Kawasaki disease. The IVGG groups are also associated with a lesser prevalence of coronary lesions, a lesser degree of severity and a greater chance of regression.
