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Kawasaki disease (KD) is a systemic vasculitis syndrome of early childhood. It involves particularly the coronary arteries and may cause aneurysms and thrombotic occlusions. Echocardiography is the most useful method of detecting coronary aneurysms. Nevertheless, obstructive lesions are difficult to evaluate and often need invasive coronary angiography. An important feature of this disease is the possibility of finding coronary pathology several years after the onset. This characteristic makes RD an important cause of coronary artery disease (CAD) in young adults. Thus patients with KD and previously diseased coronary arteries should be kept under long-term control. However, coronary angiography is invasive and cannot be performed repeatedly, especially in young patients. As an alternative, thallium 201 scintigraphy has been employed, but its low-energy photons are suboptimal for standard gamma-camera imaging, particularly in children aged less than three years. To verify the usefulness of a noninvasive assessment of myocardial perfusion, the authors used rest and dipyridamole 99mTc-Sestamibi scan in 15 children (ranging from one to six years of age) with Kawasaki's cardiac involvement. Coronary aneurysms have been demonstrated by echocardiography in 12 patients; 8 patients were also submitted to cardiac catheterization. The sensitivity of 99mTc-Sestamibi imaging for detection of overall coronary lesions was 88% and the specificity was 93%. These data suggest that rest/dipyridamole99mTc-Sestamibi scintigraphy is an accurate and noninvasive method for the detection and follow-up of Kawasaki's cardiac damage even in patients aged one year. [ABSTRACT FROM AUTHOR]

The perioperative management of patients at risk for cardiovascular diseases who undergo non-cardiac surgery has been subject of debate over the past few decades and is still of great interest. An adequate perioperative management may modify postoperative mortality and morbidity and may improve the long-term prognosis. The purpose of this review is to examine the present day knowledge regarding the preoperative evaluation and perioperative and postoperative management. In spite of the available guidelines (the American College of Cardiology and the American Heart Association of 1996) and of several studies on this subject, many controversies still persist. The main questions are: 1) the preoperative cardiovascular evaluation through non-invasive tests (and the true predictive value of the increased cardiovascular risk) and 2) the real benefit of coronary revascularization before non-cardiac surgery. The last part of this review highlights many recent clinical observations and experimental studies regarding the efficacy of the extensive use of beta-adrenergic receptor blockers and optimized anti-ischemic pharmacological therapy in reducing the cardiovascular risk of non-cardiac surgery and in improving the long-term prognosis.

Cholesterol crystal embolization syndrome is a multiorgan disease that frequently occurs as a complication of invasive cardiovascular procedures and of thrombolytic or anticoagulant therapy. The symptoms are due to the displacement of atheromatous material dislodged from unstable or injured, by mechanical manipulation, plaque to arteriolar vessels. The real incidence of cholesterol embolization is not known. Often the diagnosis is missed because of the time between intervention and clinical findings and because the organs involved can be many and various. The most common clinical manifestations are acute renal failure and hypereosinophilia. The prognosis is poor and the mortality high because of the progression of renal failure. In this case report we present the clinical history of a 62-year-old male patient with a history of cigarette smoking and hypertension who was submitted to emergency surgery following the acute dissection of a type A aortic aneurysm. About 2 weeks after surgical intervention the patient developed a multiorgan disorder (gastroenteric, neuromuscular and renal involvement) associated with hypereosinophilia and with increased levels of the markers of inflammation. The symptoms were transient and probably due to embolization of cholesterol crystals; no specific therapy was administered. On the other hand, no therapeutic regimen has been codified to date. The best clinical approach is prophylactic, that means identifying those patients who are at high risk for an invasive vascular procedure.