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Nationwide survey of pregnancy and delivery in patients with coronary arterial lesions caused by Kawasaki disease in Japan

Published online by Cambridge University Press:  22 March 2006

Etsuko Tsuda
Department of Pediatrics, National Cardiovascular Center, Osaka, Japan
Kazuya Kawamata
Department of Gynecology, National Cardiovascular Center, Osaka, Japan
Reiko Neki
Department of Gynecology, National Cardiovascular Center, Osaka, Japan
Shigeyuki Echigo
Department of Pediatrics, National Cardiovascular Center, Osaka, Japan
Yoshihide Chiba
Department of Gynecology, National Cardiovascular Center, Osaka, Japan


Background: Our purpose was to determine the outcome of pregnancy and delivery in patients with coronary arterial lesions caused by Kawasaki disease. Methods and Results: We surveyed by mail the Japanese national experience of pregnancy and delivery in patients known to have Kawasaki disease. The first questionnaire was returned by 154 of 207 (74%) institutions, and 16 of the 154 had knowledge of deliveries in their patients. Based on a second questionnaire, and previous Japanese case reports, we identified 46 deliveries in 30 patients from 16 institutions. The age at delivery ranged from 18 to 35 years, with a median of 27 years. Of the patients, 4 had undergone coronary arterial bypass grafting. Low-dose aspirin was given in 16 patients. The deliveries, 27 in all, had been vaginal in 20 patients, albeit that 7 required assistance by forceps or vacuum extraction under epidural anesthesia. Caesarean section had been performed in 11 patients, 3 for obstetric indications, and 1 for chest discomfort in the third trimester. Although there were no cardiac events, obstetric complications occurred in 2. Conclusion: The results of pregnancy and delivery were favourable. The mode of delivery should be primarily determined by obstetrical considerations, rather than the coronary arterial lesions caused by Kawasaki disease. Excessive anticoagulant therapy may not be needed for this population.

Original Article
© 2006 Cambridge University Press

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Nakamura Y, Yanagawa H, Harada K, Kato H, Kawasaki T. Mortality among patients with a history of Kawasaki disease: the third look. Acta Paediatr Jpn 2002; 156: 162165.Google Scholar
Tsuda E, Kamiya T, Ono Y, Kurosaki K, Echigo S. Incidence of stenotic lesions predicted by acute phase changes in coronary arterial diameter during Kawasaki Disease. Pediatr Cardiol 2005; 26: 7379.Google Scholar
Kato H, Sugimura T, Akagi T, et al. Long-term consequences of Kawasaki disease. A 10 to 21 year follow-up study of 594 patients. Circulation 1996; 94: 13791385.Google Scholar
Nolan TE, Savage RW. Peripartum myocardial infarction from presumed Kawasaki's Disease. Sou Med J 1990; 83: 13601361.Google Scholar
Arakawa K, Akita T, Nishizawa K, et al. Anticoagulant therapy during successful pregnancy and delivery in a Kawasaki disease patient with coronary aneurysm – a case report. Jpn Circ J 1997; 61: 197200.Google Scholar
Hayakawa H, Kato T. Successful pregnancy after coronary artery bypass grafting for Kawasaki disease: Acta Paediatr Jpn 1998; 40: 275277.Google Scholar
Alam S, Sakura S, Kosaka Y. Anaesthetic management for Caesarean section on a patient with Kawasaki disease. Can J Anaesth 1995; 42: 10241026.Google Scholar
Shear R, Leduc. Successful pregnancy following Kawasaki disease. Obstet Gynecol 1999; 94 (Part 2): 841.Google Scholar
Cohen WR, Steinman T, Patsner B, Snyder D, Satwicz P, Monroy P. Acute myocardial infarction in a pregnant woman at term. JAMA 1983; 250: 21792181.Google Scholar
Menegakis NE, Amstey MS. Case report of myocardial infarction in labor. Am J Obstet Gynecol 1991; 165: 13831384.Google Scholar
Ginz B. Myocardial infarction in pregnancy. J Obstet Gynecol Br Commonw 1970; 77: 610615.Google Scholar
Ginsberg JS, Hirsh J, Brill-Edwards P, Burrows R. Heparin therapy during pregnancy. Arch Intern Med 1989; 149; 22332236.Google Scholar
Sibai BM, Mirro R, Chesney CM, Leffler C. Low-dose aspirin in pregnancy. Obstet Gynecol 1989; 74: 551556.Google Scholar
Benigni A, Gregorini G, Frusca T, et al. Effect of low-dose aspirin on fetal and maternal generation of thromboxane by platelets in women at risk for pregnancy-induced hypertension. N Engl J Med 1989; 321: 357362.Google Scholar
Tsuda E, Ishihaea Y, Kawamata K, et al. Pregnancy and delivery in patients with coronary artery lesions caused by Kawasaki disease. Heart 2005; 91: 14811482.Google Scholar
Roth A, Elkayam U. Acute myocardial infarction associated with pregnancy. Ann Intern Med 1996; 125: 751762.Google Scholar
Badui E and Enciso R. Acute myocardial infarction during pregnancy and puerperium review. Angiology 1996; 47: 739756.Google Scholar
Hands ME, Jhonson MD, Saltzman DH, Rutherford JD. The cardiac, obstetric, and anesthetic management of pregnancy complicated by acute myocardial infarction. J Clin Anesth 1990; 2: 258268.Google Scholar
Makkonen M, Hietakorpi S, Orden MR, Saarikoski S. Myocardial infarction during pregnancy. Eur J Obstet and Gynecol Reprod Biol 1995; 58: 8183.Google Scholar
Collins JS, Bossone E, Eagle KA, Mephta RH. Asymptomatic coronary artery disease in a pregnant patient. Herz 2002; 27: 548554.Google Scholar
Kulka PJ, Scheu C, Tryba M, Oberheiden R, Zenz M. Coronary artery plaque disruption as cause of acute myocardial infarction during Cesarean section with spinal anesthesia. J Clin Anesth 2000; 12: 335338.Google Scholar
Frenkel Y, Barkai G, Reisin L, Rath S, Mashiach S, Battler A. Pregnancy after myocardial infarction: Are we playing safe? Obstet Gynecol 1991; 77: 822825.Google Scholar