It is 50 years since Kawasaki disease (KD), a pediatric febrile disorder, was first reported. As of 2014, patients with a confirmed history of KD amounted to 300,000. Among them, adult population accounted for almost a half, 140,000, and increased fourfold for the last 15 years. The incidence of coronary involvement in children during acute KD was 18.7% and 17.2% before and during the initial period of application of high dose intravenous immunoglobulin therapy, respectively, which suggests the high incidence of coronary involvement in the present adult KD population. In addition, among adults with a history of acute coronary syndrome, the population with a ‘missed’ history of KD surpass those with a confirmed history of KD. Therefore, KD-related coronary sequela is currently a matter of daily cardiac practice in adults and will be increasing in the near future. Previous studies showed endothelial dysfunction and chronic inflammation in coronary vessels in KD patients with coronary involvement, and further demonstrated vascular calcification and potential atherosclerosis in such vessels. However, the pathophysiology of these findings is still unclear, which need to be elucidated.
Very recently, percutaneous catheter intervention for ischemic heart disease or acute coronary syndrome in KD adults confers the opportunity to elucidate the mechanisms involved in the development of coronary sequelae and the treatment impact by using various imaging modalities (e.g. IVUS, OCT, angiosopy, CT, MRI, FDG-PET etc.) However, pathobiology of the coronary disease and mechanisms involved in the treatment effects has been poorly understood. In this symposium, recent investigations and case studies which give an insight into the mechanisms of such events will be discussed.