Follow-up Care for Kawasaki Disease
The follow-up care for patients with Kawasaki disease should be stratified based on the degree of coronary artery involvement, with patients requiring regular cardiology assessments at 4-6 weeks, 3-6 months, and 1 year after the acute episode, with ongoing follow-up determined by their risk level. 1
Risk Stratification
Follow-up care should be tailored to the patient's risk level based on coronary artery involvement:
Risk Level I (No Coronary Artery Changes)
- Initial follow-up: Cardiology evaluation at 4-6 weeks after acute episode
- Subsequent follow-up: May be discharged from cardiology care if normal at 4-6 weeks
- Long-term follow-up: Cardiovascular risk assessment every 5 years 1
- Medication: Discontinue aspirin after 4-6 weeks
- Physical activity: No restrictions after 4-6 weeks
Risk Level II (Transient Coronary Artery Ectasia/Dilation)
- Initial follow-up: Cardiology evaluation at 4-6 weeks after acute episode
- Subsequent follow-up: May continue follow-up to 12 months
- Long-term follow-up: Cardiovascular risk assessment every 3-5 years 1
- Medication: Discontinue aspirin after 4-6 weeks
- Physical activity: No restrictions after 4-6 weeks
Risk Level III (Small-Medium Coronary Artery Aneurysm)
- Initial follow-up: Cardiology evaluation at 4-6 weeks, then at 3 months, 6 months, and 1 year
- Long-term follow-up: Every 6-12 months 1
- Medication: Low-dose aspirin (3-5 mg/kg/day) until aneurysm regression
- Additional testing: Consider stress testing with myocardial perfusion evaluation for patients 11-20 years old
- Physical activity: For patients <11 years, no restrictions; for patients 11-20 years, guided by stress test results
Risk Level IV (Large or Giant Coronary Artery Aneurysm)
- Initial follow-up: Weekly echocardiography in the first 45 days, then monthly until 3 months, then quarterly until 1 year 2
- Long-term follow-up: Every 6 months 3
- Medication: Long-term antiplatelet therapy; warfarin may be added for giant aneurysms
- Additional testing: Annual stress tests with myocardial perfusion evaluation
- Physical activity: Guided by stress test results; avoid collision or high-impact sports
Components of Follow-up Evaluation
Echocardiographic Assessment
- Coronary artery dimensions with Z-scores
- Left ventricular function
- Valvular regurgitation assessment
- Aortic root dimensions 1, 4
Cardiovascular Risk Factor Assessment
- Blood pressure measurement
- Fasting lipid profile
- Body mass index (and plotting)
- Waist circumference
- Dietary and activity assessment
- Smoking status 1
Additional Imaging for Higher Risk Patients
- Stress testing: For patients with medium to large aneurysms to assess for inducible myocardial ischemia
- Advanced imaging: Consider CT angiography, MRI, or invasive angiography for patients with persistent aneurysms to better visualize distal coronary segments 1, 5
Important Considerations
Regression of Aneurysms
- Approximately 50% of coronary artery aneurysms show regression within 1-2 years 1
- Even after regression, structural and functional abnormalities may persist, requiring continued follow-up 1
- Risk factors for persistent aneurysms include age ≤1 year, delayed IVIG treatment, and non-response to initial IVIG 6
Long-term Complications
- Stenosis risk increases with longer follow-up time, particularly in patients with giant aneurysms 7
- Thrombosis leading to myocardial infarction is the leading cause of death, most often occurring in the first year 1
Practical Follow-up Tips
- Use standardized imaging protocols with Z-scores rather than absolute dimensions to account for patient growth 2
- As children grow, echocardiographic visualization becomes more difficult, necessitating advanced imaging techniques 2
- Annual influenza vaccination is recommended for patients on long-term aspirin therapy 1
By following these guidelines, clinicians can provide appropriate surveillance for patients with Kawasaki disease, potentially preventing or identifying early complications that may impact morbidity and mortality.