Giant coronary aneurysms in children with Kawasaki disease and major cardiac complications and dynamic follow-up

doi:10.5409/wjcp.v14.i4.108920

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World Journal of Clinical Pediatrics

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2219-2808

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Clin Pediatr. Dec 9, 2025; 14(4): 108920
Published online Dec 9, 2025. doi: 10.5409/wjcp.v14.i4.108920

Giant coronary aneurysms in children with Kawasaki disease and major cardiac complications and dynamic follow-up

Liudmila V Bregel, Olesya S Efremova, Vladimir A Podkamenny, Yurii A Kozlov, Mikhail M Kostik

Liudmila V Bregel, Olesya S Efremova, Department of Pediatric Cardiology, Irkutsk Regional Children’s Clinical Hospital, Irkutsk 664022, Russia

Liudmila V Bregel, Olesya S Efremova, Department of Pediatry, Irkutsk State Medical Academy of Postgraduate Education, A Branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia

Vladimir A Podkamenny, Department of Cardiovascular Surgery and Angiology, Irkutsk State Medical Academy of Postgraduate Education, A Branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia

Vladimir A Podkamenny, Department of Cardiosurgery, Irkutsk Regional Hospital, Irkutsk 664079, Russia

Yurii A Kozlov, Department of General Surgery, Irkutsk State Regional Children's Clinical Hospital, Irkutsk 664022, Russia

Yurii A Kozlov, Department of Pediatrics and Pediatric Surgery, Irkutsk State Medical University, Irkutsk 664003, Russia

Yurii A Kozlov, Department of Pediatric Surgery, Irkutsk State Medical Academy of Postgraduate Education, A Branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk 664049, Russia

Mikhail M Kostik, Hospital Pediatry, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Sankt-Peterburg, Russia

Author contributions: Bregel LV and Efremova OS contributed equally to this article; Bregel LV, Efremova OS, and Podkamenny VA contributed to validation; Bregel LV, Efremova OS, and Kostik MM contributed to conceptualization, writing review, editing, writing the original draft, funding, supervision, and project administration; Efremova OS and Podkamenny VA contributed to software, resources, and data curation; Efremova OS and Kostik MM contributed to formal analysis; Podkamenny VA and Kozlov YA contributed to investigation and visualization; Kozlov YA and Kostik MM contributed to the methodology; All authors read and agreed to the published version of the manuscript.

Institutional review board statement: The research paper was reviewed and approved by the Ethics Committee of Irkutsk Regional Children’s Hospital.

Informed consent statement: Informed consent was obtained from all legal representatives of patients to participate in the study, process its results, and publish materials.

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Mikhail M Kostik, MD, PhD, Professor, Hospital Pediatry, Saint Petersburg State Pediatric Medical University, Lytovskaya 2, Saint Petersburg 194100, Sankt-Peterburg, Russia. kost-mikhail@yandex.ru

Received: April 28, 2025
Revised: May 25, 2025
Accepted: August 12, 2025
Published online: December 9, 2025
Processing time: 186 Days and 23.2 Hours

Abstract

BACKGROUND

Giant coronary artery aneurysms (CAA), entailing thrombosis, myocardial infarction, and sudden death, are the most severe and life-threatening complications of Kawasaki disease (KD). Giant aneurysms rarely regress and can later transform into stenoses. Data on dynamic follow-up are scarce in the literature.

AIM

To evaluate clinical features and long-term outcomes of giant CAA in children with KD.

METHODS

A single-center retrospective study included data from patients with KD and giant CAA in the Irkutsk region (2012-2023). CAA criteria according to the American Heart Association guidelines of 2017 were used: (1) Dilated coronary artery with diameter Z-score > 2 standard deviations (SD) but < 2.5 SD; (2) Small CAA with Z-score > 2.5 SD but < 5 SD; (3) Medium CAA with Z-score > 5 SD but < 10 SD; and (4) Giant CAA with Z-score > 10 SD or ≥ 8 mm.

RESULTS

The mean age of children with coronary dilatation/aneurysms was 2.5 years, and the male-to-female ratio was 3:1. Patients with giant/medium CAA had symptoms of cerebral dysfunction more often compared with children with moderate (Z-score < 5 SD but > 2.0 SD) coronary dilatation (62.0% vs 21.0%, P = 0.019). Major cardiovascular events (myocardial infarction, coronary artery bypass grafting, acute coronary syndrome, ischemic cardiomyopathy, left ventricular aneurysm, and giant extracardiac aneurysm) occurred in 55.5% of patients who had giant CAA. At follow-up the complete regression of giant/medium CAA was observed in 58.0% and partial regression in 42.0% after a mean of 2.3 and 5.5 years, respectively. All thrombi detected by echocardiography, CT, and angiography in giant/medium CAA disappeared between 1 year and 5 years (mean: 15 months). All patients survived.

CONCLUSION

Risk factors for giant CAA were male sex, early age, and cerebral dysfunction. Complete regression of giant coronary aneurysms occurred in 58.0% of patients after follow-up of 2.3 years.

Keywords: Kawasaki disease; Children; Coronary arteries; Giant coronary aneurysms; Coronary artery dilatation; Myocardial infarction; Coronary thrombosis

Core Tip: A study of the evolution of giant and medium-sized coronary aneurysms in children with Kawasaki disease was conducted. Giant coronary aneurysms occurred in 6.5% of patients with Kawasaki disease, and 75.0% of patients with giant/medium coronary aneurysms were male. Only males had giant bilateral coronary aneurysms. Major cardiac events occurred in 38.5% of patients with giant/medium coronary aneurysms. Slow regression of giant/medium-sized coronary aneurysms occurred in all patients, complete regression occurred in 58.0%, and partial regression in 42.0% after an average of 2-4 months (from 1 year to 5 years) of observations with antithrombotic treatment. There were no fatal outcomes.