Skip to main content Accesibility Help

Biopsy-proven myocardial sequels in Kawasaki disease with giant coronary aneurysms

  • Susumu Yonesaka (a1), Toru Takahashi (a2), Shuji Eto (a2), Takumi Sato (a2), Katuki Otani (a2), Tomomi Ueda (a2), Akira Sato (a2), Yosuke Kitagawa (a2), Yuki Konno (a2) and Manabu Kinjo (a2)...

Although most Kawasaki disease with giant coronary aneurysms is asymptomatic, conventional investigations might not identify previous lesions, or all Kawasaki disease with giant aneurysms at risk of future myocardial lesions. We evaluated the long-term histopathology of the myocardium, especially of intramural small vessels in asymptomatic Kawasaki disease with giant aneurysms.


The initial study comprised 16 consecutive Kawasaki patients – male-to-female ratio was 12:4 – aged from 2 to 12 years, and in the subsequent study, the same patients were aged from 4.9 to 16 years. Endomyocardial biopsies were histopathologically evaluated. Microangiopathies, mitochondrial abnormalities, and loss or disarray of myofibrils were compared by electron microscopy.


The incidence of histopathological abnormalities such as degeneration, hypertrophy, and inflammatory cell infiltration was quite high in the initial study, and inflammatory cell infiltration, interstitial fibrosis, and disarray were very noticeable at follow-up biopsies. The area of fibrous tissue was significantly higher in patients administered with intravenous immunoglobulin at follow-up biopsies. Electron microscopy showed microangiopathies including microthrombi within intramural small vessels in some patients at follow-up biopsies. The sites of the coronary aneurysms did not seem to have an impact on the biopsy findings, suggesting that the underlying pathophysiology is related to the original disease process.


Whether the abnormalities were due to direct myocardial injury, chronic ischaemia, repeated small-vessel thrombosis, or other problems associated only with biopsies, is difficult to determine. However, this subgroup had residual abnormal lesions in the myocardium. Follow-up should be more aggressive in this group of patients to identify myocardial damage that could be asymptomatic.

Corresponding author
Correspondence to: S. Yonesaka, Department of Nursing, School of Health Sciences, Hirosaki University, 66-1 Honcho, Hirosaki, 036-8564 Japan. Tel: +81 172 395947; Fax: +81 172 395947; E-mail:
Hide All
1. Iemura, M, Ishii, M, Sugimura, T, Akagi, T, Kato, H. Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function. Heart 2000; 83: 307311.
2. Ishii, M, Ueno, T, Ikeda, H, et al. Sequential follow-up results of catheter intervention for coronary artery lesions after Kawasaki disease: quantitative coronary artery angiography and intravascular ultrasound imaging study. Circulation 2002; 105: 30043010.
3. Suzuki, A, Kamiya, T, Arakaki, Y, Kinoshita, Y, Kimura, K. Fate of coronary arterial aneurysms in Kawasaki disease. Am J Cardiol 1994; 74: 822824.
4. Yonesaka, S, Takahashi, T, Matubara, T, et al. Histopathological study on Kawasaki disease with special reference to the relation between the myocardial sequelae and regional wall motion abnormalities of the left ventricle. Jpn Circ J 1992; 56: 352358.
5. Yutani, C, Okano, K, Kamiya, T, et al. Histopathological study on right endomyocardial biopsy of Kawasaki disease. Br Heart J 1980; 43: 589592.
6. Kawasaki, T. Kawasaki disease. Nippon Rinsho 2001; 59 (Suppl 8): 823832; (in Japanese).
7. Sekiguchi, M, Hiroe, M, Moritomo, S. On the standardization of histopathological diagnosis and semiquantitative assessment of the endocardium obtained by endomyocardial biopsy. Bull Heart Inst Jpn 1979–1980; 20: 5585.
8. Yonesaka, S, Becker, AE. Dilated cardiomyopathy: diagnostic accuracy of endomyocardial biopsy. Br Heart J 1987; 58: 156161.
9. Yonesaka, S, Takahashi, T, Furukawa, H, et al. Histopathological analysis of myocardial damages following Kawasaki disease with repeated endomyocardial biopsy. Kokyu To Junkan 1992; 40: 375381.
10. Yutani, C, Go, S, Kamiya, T, et al. Cardiac biopsy of Kawasaki disease. Arch Pathol Lab Med 1981; 105: 470473.
11. Haneda, N, Mori, C. Histopathologic and coronary angiographic assessment of effectiveness of aspirin or aspirin-and-gammaglobulin in Kawasaki disease. Acta Paediatr Jpn 1993; 35: 294297.
12. Mori, M, Tomono, N, Yokota, S. Coronary arteritis of Kawasaki disease unresponsive to high-dose intravenous gammaglobulin successfully treated with plasmapheresis. Nihon Rinsho Meneki Gakkai Kaishi 1995; 18: 282288.
13. Liu, AM, Ghazizadeh, M, Onouchi, Z, Asano, G. Ultrastructural characteristics of myocardial and coronary microvascular lesions in Kawasaki disease. Microvasc Res 1999; 58: 1027.
14. Onouchi, Z, Hamaoka, K, Sakata, K, et al. Long-term changes in coronary artery aneurysms in patients with Kawasaki disease: comparison of therapeutic regimens. Circ J 2005; 69: 265272.
15. Takeuchi, M, Matsushita, T, Kurotobi, S, Sano, T, Kogaki, S, Ozono, K. Application of signal-averaged electrocardiogram to myocardial damage in the late stage of Kawasaki disease. Circ J 2006; 70: 14431445.
16. Genma, Y, Ogawa, S, Zhang, J, Yamamoto, M. Evaluation of myocardial ischemia in Kawasaki disease by dobutamine stress signal-averaged ventricular late potentials. Cardiovasc Res 1997; 36: 323329.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed