Kawasaki Disease
Kawasaki disease is a rare condition that predominantly occurs in young children (usually under 5yrs of age). The symptoms of Kawasaki are similar to those in an infection making it harder to diagnose. A bacterial or viral cause has not been identified and as such Kawasaki disease is not contagious and can not be passed from person to person
Drs believe that some people may be more genetically predisposed to it as it appears to be more common in children from North East Asia, especially Japan and Korea.
How is the heart affected by Kawasaki?
Kawasaki Disease causes medium-sized blood vessels in the body to become inflamed and swollen. The blood vessels that supply the heart with blood (coronary arteries) can become involved causing complications.
Around 25% of children with Kawasaki disease develop complications with their heart. Many of the coronary changes and heart issues are temporary or improve over time.
Presentations
The presentation is variable as may of the features below are common in many childhood infections
The characteristic symptoms are
High fever for 5 days or more with
Rash
Swollen glands in the neck
.
Dry, swollen cracked lips
Red fingers or Toes
(peeling of the skin on the hands / fingers and toes is sometimes seen later in the illness.
Conjunctivitis (or red eyes)
Investigations
The diagnosis is made by clinically. Blood tests and a heart scan (echocardiography) can help, which is able to visualise the PDA, aorta and pulmonary blood vessels. The size and flow characteristics across the PDA are determined, together with overall haemodynamic effect on the other cardiac structures. An electrocardiogram (ECG) is also performed to assess for dilatation of the left ventricle.
Treatment
The treatment your child will need will depend upon the size of the PDA and any other heart problems they might have.
a) No treatment needed
Tiny PDA’s that are not audible even with the use of a stethoscope are too small to cause any haemodynamic effect & are not associated with any medical problems. Patients may be discharged from further cardiac care.
b) Key-hole procedure
(cardiac catheterisation with PDA device occlusion) - For haemodynamic and audible ducts. This approach avoids the need for cardiac surgery. A short anaesthetic is given. A special catheter plug is then deployed across the PDA thereby occluding it. The PDA device remains fixed in position within the ductus. The procedure lasts approximately 2 hrs and patients are discharged home the same day.
Cardiac surgery
Child Heart Surgery is reserved for haemodynamically important lesions that are not amenable to catheter intervention, if for example the duct is very large, or baby very small. The aim of surgery is to ligate (tie-off) the duct and remove this abnormal source of blood flow. This type of operation is usually very straightforward and does not require the use of cardio-pulmonary bypass. Commonly, the operation can be performed by performing a small incision at the side of the chest (under the armpit) avoiding a scar on the front of the chest.
Follow Up
The long-term outlook for PDA’s is very good irrespective of the strategy used to close the hole (catheter device closure or cardiac surgery). Further surgical or catheter procedures are not usually required and children lead normal healthy lives.
