Abstract
Coronary artery (CA) dilatations are typical to Kawasaki disease (KD) in the pediatric population. CA involvement is a useful feature to help establish the diagnosis of KD. Since myocarditis is omnipresent in the acute phase of KD, we sought to investigate whether viral myocarditis may cause CA dilatation. This retrospective study reviewed 14 consecutive patients diagnosed with acute myocarditis at CHU Sainte-Justine, Montreal. KD diagnosis was excluded for all patients. All echocardiography studies were reviewed by an independent experienced echocardiographer for CA size and myocardial function parameters. CA involvement was classified under three categories: definite dilatation (Z-score ≥2.5 in one or more CA), occult dilatation (Z-score variation ≥2 points for the same CA on two different echocardiograms, but maximum Z-score always <2.5), and no dilatation otherwise. Demographics, laboratory values, microbial etiology testing, and diagnostic studies were collected from medical records. Mean age at presentation was 1.67 ± 3.22 years, where 11/14 (78 %) presented with acute and three with subacute myocarditis. Five (36 %) patients had normal CA measurements, six (43 %) had occult dilatation, and three (21 %) had definite dilatation. Maximal CA Z-score was within the first 8 days of presentation. Patients with viral myocarditis can present CA dilatation during the acute phase of the illness. This finding should be taken into account when KD diagnosis is being based on the CA involvement as the two illnesses may present with similar features.
Similar content being viewed by others
References
Muniz JC, Dummer K, Gauvreau K, Colan SD, Fulton DR, Newburger JW (2013) Coronary artery dimensions in febrile children without Kawasaki disease. Circ Cardiovasc Imag 6(2):239–244
Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS et al (2004) Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 110(17):2747–2771
Kantor PF, Lougheed J, Dancea A, McGillion M, Barbosa N, Chan C, Dillenburg R, Atallah J, Buchholz H, Chant-Gambacort C et al (2013) Presentation, diagnosis, and medical management of heart failure in children: Canadian cardiovascular society guidelines. Can J Cardiol 29(12):1535–1552
Dallaire F, Dahdah N (2011) New equations and a critical appraisal of coronary artery Z scores in healthy children. J Am Soc Echocardiogr 24(1):60–74
Dallaire F, Fournier A, Breton J, Nguyen TD, Spigelblatt L, Dahdah N (2012) Marked variations in serial coronary artery diameter measures in Kawasaki disease: a new indicator of coronary involvement. J Am Soc Echocardiogr 25(8):859–865
Pettersen MD, Du W, Skeens ME, Humes RA (2008) Regression equations for calculation of z-scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 21(8):922–934
Kampmann C, Wiethoff C, Wenzel A, Stolz G, Betancor M, Wippermann C, Huth R, Habermehl P, Knuf M, Emschermann T, Stopfkuchen H (2000) Heart. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart 83(6):667–672
Schultheiss HP, Kühl U, Cooper LT (2011) The management of myocarditis. Eur Heart J 32(21):2616–2625
Marchant DJ, Boyd JH, Lin DC, Granville DJ, Garmaroudi FS, McManus BM (2012) Inflammation in myocardial diseases. Circ Res 110(1):126–144
Abe T, Tsuda E, Miyazaki A, Ishibashi-Ueda H, Yamada O (2013) Clinical characteristics and long-term outcome of acute myocarditis in children. Heart Vessels 28(5):632–638
Durani Y, Egan M, Baffa J, Selbst SM, Nager AL (2009) Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med 27(8):942–947
Felker GM, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Baughman KL, Hare JM (2000) Echocardiographic findings in fulminant and acute myocarditis. J Am Coll Cardiol 36(1):227–232
Feldman AM, McNamara D (2000) Myocarditis. New Engl J Med 343(19):1388–1398
Rocholl C, Gerber K, Daly J, Pavia AT, Byington CL (2004) Adenoviral infections in children: the impact of rapid diagnosis. Pediatrics 113(1 Pt 1):e51–e56
Burch GE, Tsui CY, Harb JM (1971) Pathologic changes of aorta and coronary arteries of mice infected with Coxsackie B4 virus. P Soc Exp Biol Med 137(2):657
Kikuta H, Sakiyama Y, Matsumoto S, Hamada I, Yazaki M, Iwaki T, Nakano M (1993) Detection of Epstein-Barr-Virus DNA in cardiac and aortic tissues from chronic, active Epstein-Barr-Virus infection associated with Kawasaki disease-like coronary-artery aneurysms. J Pediatr 123(1):90–92
Kato S, Yoshimura K, Tanabe Y, Kimata T, Noda Y, Kawasaki H, Kaneko K (2013) A child with Epstein-Barr Virus-associated hemophagocytic lymphohistiocytosis complicated by coronary artery lesion mimicking Kawasaki disease. J Pediat Hematol Oncol 35(7):E317–E319
Harada M, Yokouchi Y, Oharaseki T, Matsui K, Tobayama H, Tanaka N, Akimoto K, Takahashi K, Kishiro M, Shimizu T et al (2012) Histopathological characteristics of myocarditis in acute-phase Kawasaki disease. Histopathology 61(6):1156–1167
Printz BF, Sleeper LA, Newburger JW, Minich LL, Bradley T, Cohen MS, Frank D, Li JS, Margossian R, Shirali G et al (2011) Noncoronary cardiac abnormalities are associated with coronary artery dilation and with laboratory inflammatory markers in acute Kawasaki disease. J Am Coll Cardiol 57(1):86–92
Adjagba PM, Desjardins L, Fournier A, Spigelblatt L, Montigny M, Dahdah N (2015) N-terminal pro-brain natriuretic peptide in acute Kawasaki disease correlates with coronary artery involvement. Cardiol Young 25(7):1311–1318
Nicholson GT, Hsu DT, Colan SD, Manwani D, Burton WB, Fountain D, Lopez L (2011) Coronary artery dilation in sickle cell disease. J Pediatr 159(5):789–794
Kaufmann P, Vassalli G, Lupi-Wagner S, Jenni R, Hess OM (1996) Coronary artery dimensions in primary and secondary left ventricular hypertrophy. J Am Coll Cardiol 28(3):745–750
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Rached-D’Astous, S., Boukas, I., Fournier, A. et al. Coronary Artery Dilatation in Viral Myocarditis Mimics Coronary Artery Findings in Kawasaki Disease. Pediatr Cardiol 37, 1148–1152 (2016). https://doi.org/10.1007/s00246-016-1411-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-016-1411-x