Complications And Prognosis

Studies of large numbers of children have established that cardiac echocardiography is an accurate method to detect and monitor coronary artery dilatation and aneurysms in children with KD (2). Children with no coronary artery changes detectable by echocardiogram during the acute phase may have clinically silent myocardial fibrosis and impaired vasodilatory capacity of coronary and peripheral arteries (59). Thus, the long-term effects on the cardiovascular system remain uncertain for all children. For children with coronary artery aneurysms, approximately 25% will develop coronary artery stenosis (60) and may subsequently require treatment for myocardial ischemia including percutaneous translum-inal angioplasty, coronary artery stenting, arterial bypass grafting, and even cardiac transplantation (2).

Sensorineural hearing loss as a complication of KD may be diagnosed, particularly in young infants, long after the resolution of acute illness. Because KD is a self-limited illness that resolves even in the absence of specific therapy, the diagnosis may be missed and the illness forgotten. Thus, a history of a rash/fever illness compatible with KD should be sought in any child undergoing evaluation of unexplained sensorineural hearing loss. Suspicion of missed KD should prompt referral to a pediatric cardiologist for echocardio-graphy to detect possible coronary artery abnormalities.

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