Mid-term Results of Heparin and Exercise Therapy for Patients with Myocardial Ischemia after Kawasaki Disease

Background: We previously reported the short-term efficacy of heparin and exercise (HE) therapy on the alleviation of myocardial ischemia in the collateral-dependent area after Kawasaki Disease (KD). Purpose: We studied mid-term efficacy o f this therapy for KD patients. Methods: Six patients, aged 9 to 20 years, who received HE therapy between 1997 and 1999 were studied. All patients had total obstruction in left or right coronary artery system. Dipyridamole-loading 99m technetiu m-tetrofos min single photon emission computed tomography (SPECT) had documented improved myocardial perfusion in all patients within 1 week after HE therapy. Two of the 6 patients received additional HE therapy within 1 year because they still had high SPECT defect scores after initial HE therapy. In all patients, dipyridamole-loading SPECT was performed at 1.5 year after initial HE therapy. Follow-up coronary angiography was performed in 3 of the 6 patients. All patients have been maintained on anti-p latelet therapy. Results: None developed anginal attack during follow-up. Follow-up dipyridamole-loading SPECT documented that total defect scores remained unchanged (n=1) or decreased (n=5) compared with those at baseline, and also remained unc h anged (n=1), increased (n=1) or decreased (n=4) compared with those within 1 week after initial HE therapy. Coronary angiography documented the development of collateral vessels in 2 of 3 patients studied. Conclusions: The present study sugges t ed that the HE therapy might have a favorable mid-term effect on alleviation of myocardial ischemia in patients with total coronary obstruction.