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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Sudden Cardiac Death in the Late-Phase Kawasaki Disease

  • Chihiro Mori1,2
  • Teruo Sekimoto3
  • Akihito Kato2
  • Maria Mihara3
  • Kenji Dohi2
  • Toshiro Shinke3
  • Taka-aki Matsuyama1
  1. 1Department of Legal Medicine, School of Medicine, Showa Medical University School, Tokyo, Japan
  2. 2Department of Emergency, Critical Care and Disaster Medicine, School of Medicine, Showa Medical University, Tokyo, Japan
  3. 3Division of Cardiology, Department of Medicine, Showa Medical University, Tokyo, Japan
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Abstract

Background: Long-term coronary complications of Kawasaki disease (KD) remain a critical concern, even after the apparent regression of coronary artery aneurysms (CAAs).

Case Summary: A 40-year-old male with a history of childhood KD suffered sudden cardiac arrest. Emergency coronary angiography revealed a "lotus root" appearance in the right coronary artery (RCA) and left main trunk (LMT) occlusion. Despite resuscitation efforts, the patient died. Autopsy showed no macroscopic CAAs. Histologically, the RCA demonstrated mature microvessels with distinct elastic laminae, whereas the LMT showed severe intimal thickening and acute thrombus.

Discussion: While CAA regression is often considered favorable, persistent, irreversible transmural remodeling can silently progress and lead to fatal ischemic events.

Take-Home Messages: Morphological regression of CAAs does not equate to histological healing. Long-term surveillance should evaluate vascular remodeling and myocardial ischemia beyond simple lumen diameter.

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Cite

BibTeXRIS
BibTeX
@article{mori2026sudden,
  title = {{Sudden Cardiac Death in the Late-Phase Kawasaki Disease}},
  author = {Chihiro Mori and Teruo Sekimoto and Akihito Kato and Maria Mihara and Kenji Dohi and Toshiro Shinke and Taka-aki Matsuyama},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.110005},
  url = {https://doi.org/10.1016/j.jaccas.2026.110005},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Sudden Cardiac Death in the Late-Phase Kawasaki Disease
AU  - Chihiro Mori
AU  - Teruo Sekimoto
AU  - Akihito Kato
AU  - Maria Mihara
AU  - Kenji Dohi
AU  - Toshiro Shinke
AU  - Taka-aki Matsuyama
PY  - 2026
DA  - 2026/08/25
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.110005
UR  - https://doi.org/10.1016/j.jaccas.2026.110005
AB  - Background: Long-term coronary complications of Kawasaki disease (KD) remain a critical concern, even after the apparent regression of coronary artery aneurysms (CAAs).  Case Summary: A 40-year-old male with a history of childhood KD suffered sudden cardiac arrest. Emergency coronary angiography revealed a "lotus root" appearance in the right coronary artery (RCA) and left main trunk (LMT) occlusion. Despite resuscitation efforts, the patient died. Autopsy showed no macroscopic CAAs. Histologically, the RCA demonstrated mature microvessels with distinct elastic laminae, whereas the LMT showed severe intimal thickening and acute thrombus.  Discussion: While CAA regression is often considered favorable, persistent, irreversible transmural remodeling can silently progress and lead to fatal ischemic events.  Take-Home Messages: Morphological regression of CAAs does not equate to histological healing. Long-term surveillance should evaluate vascular remodeling and myocardial ischemia beyond simple lumen diameter.
SN  - 2666-0849
ER  -