Akademik Veri Yönetim Sistemi
TURK KARDIYOLOJI DERNEGI ARSIVI-ARCHIVES OF THE TURKISH SOCIETY OF CARDIOLOGY, cilt.38, sa.1, ss.20-24, 2010 (ESCI, Scopus, TRDizin)
Objectives: We investigated the incidence of unresponsiveness to intravenous gamma globulin IVIG) treatment in Kawasaki disease KD) and evaluated its relation with coronary artery involvement. Study design: The study included 20 children 13 boys, 7 girls; mean age 4.2 +/- 3.4 years; range 9 months to 12 years) with KD. The mean disease duration on admission was 7.3 +/- 2.4 days range 5 to 14 days). Initial treatment consisted of a single dose of IVIG and high-dose of aspirin. Unresponsiveness was defined as the persistence of fever and other symptoms within the first 48 hours of treatment. All the patients were evaluated by two-dimensional echocardiography before and after treatment. The mean follow-up period was 16.5 +/- 2.8 months range 9 to 24 months). Results: Unresponsiveness was seen in five patients 25%), who received a subsequent dose of IVIG, which improved fever in two patients. The remaining three patients received high-dose methylprednisolone. One patient who showed no response to either IVIG or methylprednisolone was treated with low-dose oral methotrexate. Six patients 30%) had coronary artery involvement 4 dilatations, 2 aneurysms), five patients on admission echocardiography, and one patient on control echocardiography seven days after treatment. Of five unresponsive patients, four 80%) had coronary artery involvement on admission. Patients with coronary involvement underwent coronary angiography after a mean of one year. Five patients had normal coronary arteries, whereas no angiographic regression was observed in one patient who had a giant coronary artery aneurysm on admission and was treated with oral methotrexate. Conclusion: The incidence of unresponsiveness to treatment was markedly high in KD patients who had coronary artery involvement on admission.