Plain old balloon angioplasty for severe coronary artery stenosis caused by Kawasaki disease in a young child with a new aneurysm in the remote stage: a case report

Abstract

Our patient was a 12-year-old girl who was diagnosed with Kawasaki disease at 6 months of age, which was refractory to treatment. One month after its onset, bilateral coronary artery aneurysms were confirmed via echocardiography. A stenotic lesion was then observed in the proximal portion of the aneurysm, located in the left anterior descending branch (LAD). At 2 years of age, the patient underwent plain old balloon angioplasty (POBA) to treat the 99% stenosis in the LAD caused by coronary artery lesions (CALs) resulting from Kawasaki disease. This improved her stenosis to 25%. Thereafter, she was treated with aspirin and candesartan and experienced no notable symptoms or cardiovascular events. However, cardiac catheterization at 12 years of age revealed a new giant aneurysm at the POBA site. POBA represents an effective treatment method for treating myocardial ischemia in CALs after Kawasaki disease and can be safely performed in children. However, identification of new aneurysms after POBA is an important concern; hence, low-pressure dilation is recommended in this patient group. Despite the low-pressure dilatation performed in this case, a new aneurysm was found almost 10 years after the POBA was performed. Most new aneurysms form within 1 year after POBA; however, because new aneurysms can form even after 10 years, careful long- term follow-up is warranted.