Variation in the management and treatment of children with giant coronary artery aneurysm following Kawasaki disease

Authors

Mia Chen, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
Audrey Dionne, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Nadine F. Choueiter, Icahn School of Medicine at Mount Sinai Mindich Child Health and Development Institute, New York, NY, USA.
Ashraf S. Harahsheh, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Seda Tierney, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford, CA, USA.
Iñaki Navarro Castellanos, Instituto de Seguridad y Servicios Sociales de Los Trabajadores del Estado, Mexico City, Mexico.
Nagib Dahdah, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.

Document Type

Journal Article

Publication Date

11-11-2024

Journal

Cardiology in the young

DOI

10.1017/S1047951124026829

Keywords

Kawasaki disease; giant coronary artery aneurysm; global survey; management; treatment

Abstract

OBJECTIVES: Giant coronary artery aneurysms are rare but potentially fatal complications of Kawasaki disease. The lack of evidence-based recommendations on their management and treatment cause guidelines and practices to differ. We aimed to assess these variations. METHODS: An anonymous online survey regarding surveillance, imaging, pharmacological management, and interventional practices was distributed among 134 physicians attending to Kawasaki disease patients worldwide. A p-value of <0.05 was deemed significant. RESULTS: The majority (60%) of respondents were general paediatric cardiologists, and 29% interventional specialists. The average years in practice was 15 ± 9.6. Physicians from Asia had the most experience with giant coronary artery aneurysms. American practitioners preferred combining anticoagulants with aspirin. Beta-blockers and statins were more likely used in teenagers versus younger children. Cardiac catheterisation was most (52%) chosen for coronary surveillance in patients with echocardiogram anomalies, followed by Coronary CT-angiography. The indications for coronary intervention were split among respondents, regardless of geographic region or experience. The preferred treatment of coronary stenosis was percutaneous intervention (69%) versus bypass surgery. For thrombosis, thrombolytics (50%) were preferred over percutaneous (39%) and surgical (11%) interventions. Most (92%) preferred intervening in young children in a paediatric facility but were split between a paediatric and adult facility for older children. Most chose combined management by adult and paediatric specialists for either age-scenarios (70, 82%). CONCLUSION: As identified by our study, the lack of large studies and evidence-based recommendations cause uncertainty and ambivalence towards certain treatments. International collaborative efforts are needed to provide more robust evidence in the management of these patients.

APA Citation

Chen, Mia; Dionne, Audrey; Choueiter, Nadine F.; Harahsheh, Ashraf S.; Tierney, Seda; Navarro Castellanos, Iñaki; and Dahdah, Nagib, "Variation in the management and treatment of children with giant coronary artery aneurysm following Kawasaki disease" (2024). GW Authored Works. Paper 6016.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6016

Department

Pediatrics