Complete obstruction of proximal left ascending artery in a very young woman with Kawasaki: a case report and literature review

Abstract

INTRODUCTION: Kawasaki disease is a predisposing factor for various potentially fatal anomalies that can cause coronary artery diseases in childhood, adolescence, or adulthood if they are not appropriately treated, usually done with ASA and intravenous immunoglobulin (IVIG). This study presents a case of a young woman who needed a coronary artery bypass graft (CABG) due to a history of Kawasaki and coronary artery severe stenosis. CASE PRESENTATION: A 24-year-old woman presented with chest pain, exertional and at-rest dyspnea, lower limb edema, and crackle at bilateral lung bases. After stabilization, it was noted that her left anterior descending artery (LAD) had been obstructed completely. She underwent CABG successfully and recovered uneventfully. The six-month follow-up showed almost complete. His medical therapy continued with dual antiplatelet therapy, statin, diuretics, spironolactone, and some other medications to decline the process of her heart structural change (Graphical Abstract). RESULTS: Kawasaki makes the patients prone to CAD and several other CVD diseases. Many factors determine the risk of coronary artery involvement in these cases, and the proffered treatment should be chosen based on the severity of CAD and the characteristics of the patient. These treatments include (1. Medical, 2. Interventional (PCI), 3. Surgical (CABG), 4. Combinational) along with preventive therapy, which is suggested to almost all patients. In our case, considering the complete occlusion of LAD, the patient underwent CABG. CLINICAL KEY POINT: Kawasaki disease is one of the most important predisposing factors for CAD in young adults, and their least significant symptoms should be taken seriously as a CVD and should be investigated. CAD in these patients might be so severe that no treatment except CABG can be responsive to problem-solving. Moreover, timely management of disease in childhood with ASA and IVIG would prevent or at least decrease the severity of symptoms can be declined significantly.