Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions

Zenshiro Onouchi; Akiko Hamaoka-Okamoto; Chinatsu Suzuki; Kenji Hamaoka

doi:doi:10.11648/j.ccr.20210501.12

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Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions

Zenshiro Onouchi, Akiko Hamaoka-Okamoto, Chinatsu Suzuki, Kenji Hamaoka

Published in Cardiology and Cardiovascular Research (Volume 5, Issue 1)

Received: 21 November 2020 Accepted: 25 December 2020 Published: 15 January 2021

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Abstract

Backgrounds. The mechanism causing coronary artery lesions in Kawasaki disease (KD) has not yet been fully clarified. Objective. We hypothesized that the main coronary artery (MCA) segment perfused by the vasa vasorum (VV) arose from the atrial and ventricular branches of peripheral coronary arteries in the myocardium (Type 1 VV externa) is more prone to aneurysm formation than that perfused by Type 2 VV originated from the ostium. Methods and Results. We reviewed the coronary angiography and two-dimensional echocardiogram (2DE) data of KD patients in our hospital and measured the distances from the left coronary ostium to the proximal point of the aneurysm in the left MCA (D1) and to the MCA bifurcation (D2). We found that the ratio of the distances (D1/D2) was negatively correlated with the patients’ age of KD onset, indicating that longitudinal extension of the left MCA aneurysms coincided with the development of Type 1 VV externa. We performed a literature review of KD cases with extracardiac aneurysms and found that 15 patients also had giant aneurysms in the MCA. Also, 8 of 9 extracardiac aneurysm cases whose clear 2DE images were available in the reports, the giant MCA aneurysms seemed to have developed at positions immediately adjacent to the ostium. We assume that the giant coronary aneurysms might be a consequence of the coincidence of aneurysms in the MCA segments perfused by Type 1 and 2 VV externas and reflect a severe inflammation where Type 2 VV externa which is less susceptible to blood flow reduction than Type 1 VV externa is affected. Conclusions. Vasculitis in VV externa with the unique structure originating from and distributing most richly across coronary arteries might induce a vicious circle of hypoperfusion of VV externa and reduced coronary blood flow.

Published in	Cardiology and Cardiovascular Research (Volume 5, Issue 1)
DOI	10.11648/j.ccr.20210501.12
Page(s)	7-15
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Coronary Artery Aneurysm, Coronary Artery Ischemia, Coronary Blood Flow, Coronary Vasa Vasorum, Endothelial Dysfunction

References

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APA Style

Zenshiro Onouchi, Akiko Hamaoka-Okamoto, Chinatsu Suzuki, Kenji Hamaoka. (2021). Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions. Cardiology and Cardiovascular Research, 5(1), 7-15. https://doi.org/10.11648/j.ccr.20210501.12

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ACS Style

Zenshiro Onouchi; Akiko Hamaoka-Okamoto; Chinatsu Suzuki; Kenji Hamaoka. Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions. Cardiol. Cardiovasc. Res. 2021, 5(1), 7-15. doi: 10.11648/j.ccr.20210501.12

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AMA Style

Zenshiro Onouchi, Akiko Hamaoka-Okamoto, Chinatsu Suzuki, Kenji Hamaoka. Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions. Cardiol Cardiovasc Res. 2021;5(1):7-15. doi: 10.11648/j.ccr.20210501.12

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@article{10.11648/j.ccr.20210501.12,
  author = {Zenshiro Onouchi and Akiko Hamaoka-Okamoto and Chinatsu Suzuki and Kenji Hamaoka},
  title = {Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions},
  journal = {Cardiology and Cardiovascular Research},
  volume = {5},
  number = {1},
  pages = {7-15},
  doi = {10.11648/j.ccr.20210501.12},
  url = {https://doi.org/10.11648/j.ccr.20210501.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20210501.12},
  abstract = {Backgrounds. The mechanism causing coronary artery lesions in Kawasaki disease (KD) has not yet been fully clarified. Objective. We hypothesized that the main coronary artery (MCA) segment perfused by the vasa vasorum (VV) arose from the atrial and ventricular branches of peripheral coronary arteries in the myocardium (Type 1 VV externa) is more prone to aneurysm formation than that perfused by Type 2 VV originated from the ostium. Methods and Results. We reviewed the coronary angiography and two-dimensional echocardiogram (2DE) data of KD patients in our hospital and measured the distances from the left coronary ostium to the proximal point of the aneurysm in the left MCA (D1) and to the MCA bifurcation (D2). We found that the ratio of the distances (D1/D2) was negatively correlated with the patients’ age of KD onset, indicating that longitudinal extension of the left MCA aneurysms coincided with the development of Type 1 VV externa. We performed a literature review of KD cases with extracardiac aneurysms and found that 15 patients also had giant aneurysms in the MCA. Also, 8 of 9 extracardiac aneurysm cases whose clear 2DE images were available in the reports, the giant MCA aneurysms seemed to have developed at positions immediately adjacent to the ostium. We assume that the giant coronary aneurysms might be a consequence of the coincidence of aneurysms in the MCA segments perfused by Type 1 and 2 VV externas and reflect a severe inflammation where Type 2 VV externa which is less susceptible to blood flow reduction than Type 1 VV externa is affected. Conclusions. Vasculitis in VV externa with the unique structure originating from and distributing most richly across coronary arteries might induce a vicious circle of hypoperfusion of VV externa and reduced coronary blood flow.},
 year = {2021}
}

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TY  - JOUR
T1  - Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions
AU  - Zenshiro Onouchi
AU  - Akiko Hamaoka-Okamoto
AU  - Chinatsu Suzuki
AU  - Kenji Hamaoka
Y1  - 2021/01/15
PY  - 2021
N1  - https://doi.org/10.11648/j.ccr.20210501.12
DO  - 10.11648/j.ccr.20210501.12
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 7
EP  - 15
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20210501.12
AB  - Backgrounds. The mechanism causing coronary artery lesions in Kawasaki disease (KD) has not yet been fully clarified. Objective. We hypothesized that the main coronary artery (MCA) segment perfused by the vasa vasorum (VV) arose from the atrial and ventricular branches of peripheral coronary arteries in the myocardium (Type 1 VV externa) is more prone to aneurysm formation than that perfused by Type 2 VV originated from the ostium. Methods and Results. We reviewed the coronary angiography and two-dimensional echocardiogram (2DE) data of KD patients in our hospital and measured the distances from the left coronary ostium to the proximal point of the aneurysm in the left MCA (D1) and to the MCA bifurcation (D2). We found that the ratio of the distances (D1/D2) was negatively correlated with the patients’ age of KD onset, indicating that longitudinal extension of the left MCA aneurysms coincided with the development of Type 1 VV externa. We performed a literature review of KD cases with extracardiac aneurysms and found that 15 patients also had giant aneurysms in the MCA. Also, 8 of 9 extracardiac aneurysm cases whose clear 2DE images were available in the reports, the giant MCA aneurysms seemed to have developed at positions immediately adjacent to the ostium. We assume that the giant coronary aneurysms might be a consequence of the coincidence of aneurysms in the MCA segments perfused by Type 1 and 2 VV externas and reflect a severe inflammation where Type 2 VV externa which is less susceptible to blood flow reduction than Type 1 VV externa is affected. Conclusions. Vasculitis in VV externa with the unique structure originating from and distributing most richly across coronary arteries might induce a vicious circle of hypoperfusion of VV externa and reduced coronary blood flow.
VL  - 5
IS  - 1
ER  -

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Author Information

Zenshiro Onouchi

Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Kyoto, Japan
Akiko Hamaoka-Okamoto

Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Kyoto, Japan
Chinatsu Suzuki

Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Kyoto, Japan
Kenji Hamaoka

Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Kyoto, Japan

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APA Style

Zenshiro Onouchi, Akiko Hamaoka-Okamoto, Chinatsu Suzuki, Kenji Hamaoka. (2021). Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions. Cardiology and Cardiovascular Research, 5(1), 7-15. https://doi.org/10.11648/j.ccr.20210501.12

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ACS Style

Zenshiro Onouchi; Akiko Hamaoka-Okamoto; Chinatsu Suzuki; Kenji Hamaoka. Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions. Cardiol. Cardiovasc. Res. 2021, 5(1), 7-15. doi: 10.11648/j.ccr.20210501.12

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AMA Style

Zenshiro Onouchi, Akiko Hamaoka-Okamoto, Chinatsu Suzuki, Kenji Hamaoka. Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions. Cardiol Cardiovasc Res. 2021;5(1):7-15. doi: 10.11648/j.ccr.20210501.12

Copy | Download

@article{10.11648/j.ccr.20210501.12,
  author = {Zenshiro Onouchi and Akiko Hamaoka-Okamoto and Chinatsu Suzuki and Kenji Hamaoka},
  title = {Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions},
  journal = {Cardiology and Cardiovascular Research},
  volume = {5},
  number = {1},
  pages = {7-15},
  doi = {10.11648/j.ccr.20210501.12},
  url = {https://doi.org/10.11648/j.ccr.20210501.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20210501.12},
  abstract = {Backgrounds. The mechanism causing coronary artery lesions in Kawasaki disease (KD) has not yet been fully clarified. Objective. We hypothesized that the main coronary artery (MCA) segment perfused by the vasa vasorum (VV) arose from the atrial and ventricular branches of peripheral coronary arteries in the myocardium (Type 1 VV externa) is more prone to aneurysm formation than that perfused by Type 2 VV originated from the ostium. Methods and Results. We reviewed the coronary angiography and two-dimensional echocardiogram (2DE) data of KD patients in our hospital and measured the distances from the left coronary ostium to the proximal point of the aneurysm in the left MCA (D1) and to the MCA bifurcation (D2). We found that the ratio of the distances (D1/D2) was negatively correlated with the patients’ age of KD onset, indicating that longitudinal extension of the left MCA aneurysms coincided with the development of Type 1 VV externa. We performed a literature review of KD cases with extracardiac aneurysms and found that 15 patients also had giant aneurysms in the MCA. Also, 8 of 9 extracardiac aneurysm cases whose clear 2DE images were available in the reports, the giant MCA aneurysms seemed to have developed at positions immediately adjacent to the ostium. We assume that the giant coronary aneurysms might be a consequence of the coincidence of aneurysms in the MCA segments perfused by Type 1 and 2 VV externas and reflect a severe inflammation where Type 2 VV externa which is less susceptible to blood flow reduction than Type 1 VV externa is affected. Conclusions. Vasculitis in VV externa with the unique structure originating from and distributing most richly across coronary arteries might induce a vicious circle of hypoperfusion of VV externa and reduced coronary blood flow.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Vasculitis of Vasa Vasorum and Aneurysm Formation in Kawasaki Disease: Predilection for Coronary Arteries Lesions
AU  - Zenshiro Onouchi
AU  - Akiko Hamaoka-Okamoto
AU  - Chinatsu Suzuki
AU  - Kenji Hamaoka
Y1  - 2021/01/15
PY  - 2021
N1  - https://doi.org/10.11648/j.ccr.20210501.12
DO  - 10.11648/j.ccr.20210501.12
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 7
EP  - 15
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20210501.12
AB  - Backgrounds. The mechanism causing coronary artery lesions in Kawasaki disease (KD) has not yet been fully clarified. Objective. We hypothesized that the main coronary artery (MCA) segment perfused by the vasa vasorum (VV) arose from the atrial and ventricular branches of peripheral coronary arteries in the myocardium (Type 1 VV externa) is more prone to aneurysm formation than that perfused by Type 2 VV originated from the ostium. Methods and Results. We reviewed the coronary angiography and two-dimensional echocardiogram (2DE) data of KD patients in our hospital and measured the distances from the left coronary ostium to the proximal point of the aneurysm in the left MCA (D1) and to the MCA bifurcation (D2). We found that the ratio of the distances (D1/D2) was negatively correlated with the patients’ age of KD onset, indicating that longitudinal extension of the left MCA aneurysms coincided with the development of Type 1 VV externa. We performed a literature review of KD cases with extracardiac aneurysms and found that 15 patients also had giant aneurysms in the MCA. Also, 8 of 9 extracardiac aneurysm cases whose clear 2DE images were available in the reports, the giant MCA aneurysms seemed to have developed at positions immediately adjacent to the ostium. We assume that the giant coronary aneurysms might be a consequence of the coincidence of aneurysms in the MCA segments perfused by Type 1 and 2 VV externas and reflect a severe inflammation where Type 2 VV externa which is less susceptible to blood flow reduction than Type 1 VV externa is affected. Conclusions. Vasculitis in VV externa with the unique structure originating from and distributing most richly across coronary arteries might induce a vicious circle of hypoperfusion of VV externa and reduced coronary blood flow.
VL  - 5
IS  - 1
ER  -

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