[Valvular lesions complicating Kawasaki disease: a Doppler echocardiographic evaluation].

Abstract

Coronary artery aneurysms are the most frequent and important complication of Kawasaki disease, but valvular disease is less frequently observed. During the last three years, we have observed mitral regurgitation (MR) in nine (7.3%), aortic regurgitation (AR) in six (4.6%) and tricuspid regurgitation (TR) in five (4.2%) patients with Kawasaki disease. The diagnosis of valvular disease was confirmed by Doppler echocardiography in all patients. Cardiac murmurs typical of regurgitation were audible in approximately half the patients with MR and AR, and in only one with TR. By chest radiography, cardiomegaly was observed in five of nine patients with MR and in three of six with AR, but in none with TR. Similarly, the ECG finding of cardiac overload was observed in four patients with MR and in three with AR, but in none with TR. Thus, Doppler echocardiography proved very valuable for diagnosing valvular regurgitation in patients with Kawasaki disease. Other cardiovascular complications included coronary artery aneurysms in all except for only one patient with TR. Subsequent myocardial infarction was observed in three patients with MR and in two with AR. Valvular lesions complicating Kawasaki disease generally carry a good prognosis, without progression to stenotic valvular lesions. Although the exact mechanism of this complication is obscure, it is postulated that the valvular lesion results from myocardial infarction or from inflammation of the valvular leaflets or apparatus of the valve following carditis.