Venoarterial extroporeal membrane oxygenation for cardiogenic shock following acute myocardial infarction in adult Kawasaki disease: A case report.

Two young adult patients with prior Kawasaki disease presented with acute myocardial infarction complicated by cardiogenic shock without conventional cardiovascular risk factors.

• Both patients were approximately 30 years of age at presentation.
• Neither patient had traditional cardiovascular risk factors.
• AMI events were attributed to long-standing coronary sequelae of antecedent Kawasaki disease.
• Coronary angiography demonstrated coronary artery aneurysms and multivessel coronary disease in both individuals.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) successfully restored cardiac function and achieved hemodynamic stabilization in both patients during the acute critical phase.

• Both patients were supported with venoarterial extracorporeal membrane oxygenation.
• Mechanical circulatory support was used during the acute critical phase of AMI and cardiogenic shock.
• Both patients achieved clinical recovery following VA-ECMO support.
• Both patients were discharged home after treatment.

Despite successful acute-phase management, both patients developed recurrent episodes of acute heart failure during long-term follow-up.

• Recurrent acute heart failure occurred in both individuals after hospital discharge.
• The recurrent episodes occurred during subsequent long-term follow-up.
• This finding underscores that successful acute-phase management does not preclude progressive cardiac deterioration in this population.
• The authors concluded that longitudinal follow-up and rigorous cardiac surveillance remain essential for early detection and prevention of progressive heart failure.

Kawasaki disease survivors face substantially elevated risk of secondary coronary artery abnormalities as adults.

• Kawasaki disease is described as an acute, self-limiting vasculitis primarily affecting infants and young children.
• KD remains the leading cause of acquired heart disease in the pediatric population.
• With advancing disease course, adult survivors face a substantially elevated risk of developing secondary coronary artery abnormalities.
• When AMI occurs in this population, outcomes are frequently poor due to high prevalence of malignant ventricular arrhythmias and cardiogenic shock.

Prompt institution of mechanical circulatory support is critical in patients with acute coronary syndrome attributable to Kawasaki disease-related coronary artery disease when clinically indicated.

• The authors identified this as a key management principle based on the two presented cases.
• Both patients with KD-related AMI and cardiogenic shock benefited from VA-ECMO support.
• The case report underscores that even with successful acute-phase management, long-term cardiac surveillance remains essential.
• The authors emphasized the need for early detection and prevention of progressive heart failure in this high-risk population.