Histopathological study on the non-aneurysmal coronary arteries in the remote period of Kawasaki disease.

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The majority of Kawasaki disease (KD) patients recover without leaving the cardiovascular sequelae. However, the scar of vasculitis exists in the coronary artery (CA) even in these KD patients. The prognosis of the artery that remains the scar of angitiis though there is no aneurysm has not been clarified yet. We performed a pathological study on the CAs without aneurysms of the KD autopsy patients who died during remote period.Materials and Methods : Seven KD autopsy patients who had died over 40 days after the onset of illness were examined in this study. The age when patients died ranged from 1 to 15 years old. H&E, EvG, AM and Al-B stains were performed and we observed histology of the arteries, especially the component of the intima. In addition, the antibodies against the cellular growth factors (GFs) and the smooth muscle cell (SMC) phenotypes were used. The reactivity against these antibodies in the intima of CA in KD patients was compared with those of control autopsy patients.Results : The changes to which it was presumed that vasculitis had existed in the acute stage was recognized in the coronary arteries of five of seven KD patients. Two KD patients had the very slight intimal thickenings which were unremarkable compared with the control patients. On the CAs of the patients who had died within one year from the onset of KD, GFs such as PDGF and VEGF were positive for the endothelial cells and the SMCs, and the intimal SMCs showed the dedifferentiation phenotype. However, as for the coronary arteries of the patients who had died one year or more after the KD onset, the pattern of positivity of the GFs and the SMC phenotypes became similar to those of the controls.Conclusion : The scar of vasculitis remains in the non-aneurysmal coronary arteries of KD patients. However, when the lumen normalizes, the characteristics of the arteries become similar to those of the control patients. These arteries seem not to advance to the stenotic lesions in the future.