Long-Term Kawasaki Disease Complication

Figures

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  Figure 1. Radiographic Examination of the Coronary Artery Aneurysm (A) Faxitron (Hologic, Inc) radiograph of epicardial coronary arteries dissected from the heart demonstrating aneurysmal dilation and calcification of the proximal LAD artery and focal calcification of the middle LAD artery (yellow boxed area). (B) An enlarged view of the yellow boxed area in A, with yellow lines marking the levels at which histologic sections (Figures 2 and 3) were taken. LAD = left anterior descending; LCX = left circumflex artery; LM = left main; RCA = right coronary artery.

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  Figure 2. Comparative Histologic Examination and Vessel Diameter of Coronary Arteries (A to D) Sections of the coronary arteries are presented at identical magnification. (A) The maximum vessel diameter within the LAD aneurysm (numbers 2-6) was 12 mm × 10 mm (number 4). The numbers on each section align with those marked by yellow lines in Figure 1B, as well as the numbers in Figure 3. (B to D) All sections are stained with Movat pentachrome stain. Abbreviations as in Figure 1.

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  Figure 3. Histologic Examination of the Proximal LAD Artery (A) Proximal LAD artery without aneurysm formation. (B) High-power image of the boxed area in A, showing smooth muscle cells enriched with proteoglycans and collagen. (C) Occlusive acute thrombus and underlying fibrocalcific plaque. (D) Boxed area from C, showing the underlying plaque rich in smooth muscle cells embedded in a matrix rich in proteoglycans and collagen. (E) Occlusive acute thrombus and underlying fibrocalcific plaque. (F) Boxed area from E, highlighting the plaque rich in smooth muscle cells within a proteoglycan-collagen–rich matrix, between acute thrombus and sheet calcification. (G, I) Sheet calcification, organizing thrombus, and overlying acute occlusive thrombus. (H, J) High-power image from the boxed area in G and I, respectively, showing acute luminal thrombus and underlying healing plaque rich in proteoglycans, without necrotic core. Sections within the aneurysm show pronounced thinning of the media layer. (K, L) Intima is composed of smooth muscle cells that are rich in proteoglycans and collagen. (M, N) Section without aneurysm, with a vessel maximum diameter of 3.5 mm and media preserved. (O, P) Middle…

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  Figure 4. Immunostaining for Endothelial Marker Hematoxylin and eosin–stained sections of the proximal LAD artery (A, B) without CAA and (D, E) with CAA. (C, F) The presence of endothelium on the luminal surface is confirmed by CD34 immunostaining. (C) A high-power image of an adjacent section without CAA shows normal endothelialized surface (arrows). (F) Conversely, this image reveals the absence of endothelium on the luminal surface with CAA, highlighting luminal surface in direct contact with acute thrombus. CAA = coronary artery aneurysm; LAD = left anterior descending; Thr = thrombus.