5.4 Large or giant Assess every 1–2 years (may omit echo) Assess every 2–5 May consider every 5 aneurysm; regressed years years to normal or dilation only aTo include history and physical examination, echocardiography, electrocardiography bMay include stress echocardiography, stress electrocardiography, stress with MRI perfusion imaging, stress with nuclear medicine perfusion imaging cMay include imaging with angiography (computed tomography, magnetic resonance, invasive) Modified with permission from McCrindle BW, Rowley AH, Newburger JW, et al Diagnosis, treatment and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association Circulation 2017;135(17):e927–e999 A lipid profile should be obtained at least once, ideally 1 year after the onset of the illness In patients with no history of coronary aneurysms or with coronary dilation only, this lipid profile may be performed by the primary care provider However, it is important to emphasize that Kawasaki disease is part of the individual's permanent medical history Patients with coronary aneurysms should have lifelong cardiology follow-up This is particularly important as the child grows and transitions to self-care For female patients, the possibility of menorrhagia as well as reproductive counseling regarding contraception and the risks of pregnancy are important Women with coronary artery disease are at increased risk of thrombosis, and low-estrogen or progesterone-only contraceptives should be considered Cardiac status should be evaluated prior to pregnancy for the risk of ischemia, deterioration of functional status, heart failure, arrhythmia, and thrombosis Ideally these patients should be monitored by high-risk obstetric services Thromboprophylaxis may have to be adjusted during pregnancy or in severe cases of menorrhagia For women with giant aneurysms, warfarin should be discontinued owing to its teratogenic effects; it is usually replaced with heparin Statins and angiotensin-converting enzyme inhibitors must also be discontinued Successful pregnancies have been reported in patients with Kawasaki disease, both with and without coronary aneurysms with no significant complications.184,185 However, experience is limited at this time, and based only on a small number of patients Implications in Adult Life Long-term follow-up of patients in Japan has reflected higher mortality rates in males with coronary artery complications (standardized mortality ratio 2.55, 95% confidence interval 1.23 to 4.70) The mortality rate was not elevated in females with coronary artery aneurysms or patients with no coronary artery complications.186 However, patients have been followed systematically only for the last three decades, and continuing surveillance, particularly of those who had coronary aneurysms at any point in their illness, will be necessary to fully understand the long-term implications of the disease across the spectrum of severity All children who have Kawasaki disease with aneurysms, even if remodeled to normal dimensions, should have lifetime follow-up and be transitioned to expert adult cardiology care Annotated References Furusho K, Kamiya T, Nakano H, et al High-dose intravenous gammaglobulin for kawasaki disease Lancet 1984;2(8411):1055–1058 This clinical trial, performed in Japan, was the first to demonstrate the efficacy of intravenous immunoglobulin in the treatment of Kawasaki disease by reducing coronary artery complications Ishii M, Ueno T, Ikeda H, et al Sequential followup results of catheter intervention for coronary artery lesions after kawasaki disease: quantitative coronary artery angiography and intravascular ultrasound imaging study Circulation 2002;105(25):3004–3010 This manuscript reports on the largest investigative series to date, including the outcomes of 22 patients with Kawasaki disease after catheter intervention for coronary artery lesions Kato H, Ichinose E, Kawasaki T Myocardial infarction in kawasaki disease: clinical analyses in 195 cases J Pediatr 1986;108:923–927 This manuscript provides the largest series of patients with Kawasaki disease and myocardial infarction, summarizing clinical presentation ... remodeled to normal dimensions, should have lifetime follow-up and be transitioned to expert adult cardiology care Annotated References Furusho K, Kamiya T, Nakano H, et al High-dose intravenous gammaglobulin for kawasaki