Coronary angiography and right ventricular endomyocardial biopsy were performed in 36 children during
convalescence (days of illness 23-86; mean = 41.5 days) following acute
Kawasaki disease. Treatment of the acute stage was not randomized; it consisted of
aspirin alone in 14 subjects (during the years 1980-88), and gammaglobulin and
aspirin in 22 subjects (1984-91). The dosage of
aspirin was 30 mg/kg orally during the acute febrile stage and 5-10 mg/kg orally after lysis of
fever. The dosage of gammaglobulin was 200 mg/kg x 5 days in 19 patients, 200 mg/kg x 3 days in one patient, 200 mg/kg x 1 day + 400 mg/kg x 4 days in one patient and 200 mg/kg x 4 days + 400 mg/kg x 4 days in one patient. Among the 14 patients treated with
aspirin alone, large
coronary aneurysms were noted in four, moderate
aneurysms in three and transient
aneurysms in one. Among 22 patients treated with gammaglobulin, only five had
aneurysms and these were transient. The histopathological (HP) score based on myocardial disarrangement, degeneration and
hypertrophy; interstitial
edema, large mononuclear cell infiltration and
fibrosis; and endocardial abnormalities was higher in the
aspirin group than in gammaglobulin group. Moderate to severe HP changes were noted in five subjects in the
aspirin group, while moderate HP changes were found in only two subjects in the gammaglobulin group. Gammaglobulin
therapy not only reduced the incidence of the coronary arterial lesions but also reduced the severity of myocardial damage from moderate or severe to mild in
Kawasaki disease.