Hirohisa Kato*
Professor Emeritus, Dept of Pediatrics and the Cardiovascular Research Institute, Kurume University, Japan. *
The cardiovascular involvement in Kawasaki disease (KD) is a most important clinical issue, however, the longterm consequence of cardiovascular sequelae and management remain uncertain.

In 1973, we introduced coronary angiography (CAG) and found the presence of asymptomatic coronary aneurysms in many patients. From 1973 to 2003 we experienced 2,180 consecutive patients of acute KD, of which 325 (14.9%) had coronary aneurysms. These patients had been followed for more than 2 years with longest 32 years (mean: 8.5 years). Follow-up (2nd) CAG was performed in 301, of which 162 demonstrated the regression of coronary aneurysms (54%).

Further follow-up: CAG (3rd, 4th, 5th) was done in 152 cases. In the long-term pathological study the regressed aneurysms revealed the marked initial thickening mainly caused by proliferation of medial smooth muscle cells and well degenerated endothelium. Those findings were also demonstrated by intravascular ultrasound imaging in the follow-up patients. Long-term endothelial function in those patients was impaired. From this long-term follow-up study we review our data and discuss the following issues in the long-term problems of pediatric through adults in KD.
      • Cardiovascular spectrum in Kawasaki disease
      • Fate of coronary aneurysms; Regression of aneurysms and progression to coronary artery disease
      • KD vasculitis may be an atherosclerotic risk factor
      • Kawasaki disease is a part of causes of adult coronary artery disease
      • Therapeutic recommendations, including catheter interventional treatment and bypass surgery
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