Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Cardiovascular sequelae of Kawasaki disease: Clinical features and evaluation

Jane W Newburger, MD, MPH
Sarah D de Ferranti, MD, MPH
David R Fulton, MD
Section Editor
John K Triedman, MD
Deputy Editor
Carrie Armsby, MD, MPH


Kawasaki disease (KD; also called mucocutaneous lymph node syndrome) is a vasculitis of unknown etiology that generally occurs in infancy and childhood. The acute illness is self-limited and is characterized by high fever, nonexudative conjunctivitis, inflammation of the oral mucosa, rash, cervical adenopathy, and findings in the extremities, including swollen hands and feet, red palms and soles, and, later, subungual peeling. (See "Kawasaki disease: Clinical features and diagnosis" and "Kawasaki disease: Epidemiology and etiology".)

Children with KD are at risk for serious cardiovascular sequelae, particularly coronary artery abnormalities (CAAs), which can lead to myocardial ischemia, infarction, and sudden death. The risk of developing CAAs is highest among children with KD who are not treated early in the disease with high-dose intravenous immune globulin (IVIG). Thus, initial management of patients with KD is focused on early diagnosis and treatment with IVIG. (See "Kawasaki disease: Initial treatment and prognosis".)

The clinical features and evaluation of cardiac sequelae of KD, including CAA, will be reviewed here. Other aspects of KD are discussed in greater detail separately:

(See "Cardiovascular sequelae of Kawasaki disease: Management and prognosis".)

(See "Kawasaki disease: Epidemiology and etiology".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Sep 2017. | This topic last updated: Oct 05, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Fujiwara H, Hamashima Y. Pathology of the heart in Kawasaki disease. Pediatrics 1978; 61:100.
  2. Naoe S, Takahashi K, Masuda H, Tanaka N. Kawasaki disease. With particular emphasis on arterial lesions. Acta Pathol Jpn 1991; 41:785.
  3. Holman RC, Curns AT, Belay ED, et al. Kawasaki syndrome hospitalizations in the United States, 1997 and 2000. Pediatrics 2003; 112:495.
  4. Chang RK. Hospitalizations for Kawasaki disease among children in the United States, 1988-1997. Pediatrics 2002; 109:e87.
  5. Takahashi K, Oharaseki T, Naoe S, et al. Neutrophilic involvement in the damage to coronary arteries in acute stage of Kawasaki disease. Pediatr Int 2005; 47:305.
  6. Yutani C, Okano K, Kamiya T, et al. Histopathological study on right endomyocardial biopsy of Kawasaki disease. Br Heart J 1980; 43:589.
  7. Yutani C, Go S, Kamiya T, et al. Cardiac biopsy of Kawasaki disease. Arch Pathol Lab Med 1981; 105:470.
  8. Burns JC. Kawasaki Disease update. Indian J Pediatr 2009; 76:71.
  9. Suzuki A, Miyagawa-Tomita S, Komatsu K, et al. Active remodeling of the coronary arterial lesions in the late phase of Kawasaki disease: immunohistochemical study. Circulation 2000; 101:2935.
  10. Orenstein JM, Shulman ST, Fox LM, et al. Three linked vasculopathic processes characterize Kawasaki disease: a light and transmission electron microscopic study. PLoS One 2012; 7:e38998.
  11. 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:e927.
  12. Kanegaye JT, Wilder MS, Molkara D, et al. Recognition of a Kawasaki disease shock syndrome. Pediatrics 2009; 123:e783.
  13. Chen Y, Shang S, Zhang C, et al. Hemophagocytic lymphohistiocytosis at initiation of kawasaki disease and their differential diagnosis. Pediatr Hematol Oncol 2010; 27:244.
  14. Palazzi DL, McClain KL, Kaplan SL. Hemophagocytic syndrome after Kawasaki disease. Pediatr Infect Dis J 2003; 22:663.
  15. Simonini G, Pagnini I, Innocenti L, et al. Macrophage activation syndrome/Hemophagocytic Lymphohistiocytosis and Kawasaki disease. Pediatr Blood Cancer 2010; 55:592.
  16. Titze U, Janka G, Schneider EM, et al. Hemophagocytic lymphohistiocytosis and Kawasaki disease: combined manifestation and differential diagnosis. Pediatr Blood Cancer 2009; 53:493.
  17. Kato H, Ichinose E, Kawasaki T. Myocardial infarction in Kawasaki disease: clinical analyses in 195 cases. J Pediatr 1986; 108:923.
  18. Burns JC, Shike H, Gordon JB, et al. Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol 1996; 28:253.
  19. McCrindle BW, Li JS, Minich LL, et al. Coronary artery involvement in children with Kawasaki disease: risk factors from analysis of serial normalized measurements. Circulation 2007; 116:174.
  20. Suda K, Iemura M, Nishiono H, et al. Long-term prognosis of patients with Kawasaki disease complicated by giant coronary aneurysms: a single-institution experience. Circulation 2011; 123:1836.
  21. Kitamura S, Kameda Y, Seki T, et al. Long-term outcome of myocardial revascularization in patients with Kawasaki coronary artery disease. A multicenter cooperative study. J Thorac Cardiovasc Surg 1994; 107:663.
  22. Minich LL, Sleeper LA, Atz AM, et al. Delayed diagnosis of Kawasaki disease: what are the risk factors? Pediatrics 2007; 120:e1434.
  23. Muta H, Ishii M, Sakaue T, et al. Older age is a risk factor for the development of cardiovascular sequelae in Kawasaki disease. Pediatrics 2004; 114:751.
  24. Song D, Yeo Y, Ha K, et al. Risk factors for Kawasaki disease-associated coronary abnormalities differ depending on age. Eur J Pediatr 2009; 168:1315.
  25. Kim T, Choi W, Woo CW, et al. Predictive risk factors for coronary artery abnormalities in Kawasaki disease. Eur J Pediatr 2007; 166:421.
  26. Beiser AS, Takahashi M, Baker AL, et al. A predictive instrument for coronary artery aneurysms in Kawasaki disease. US Multicenter Kawasaki Disease Study Group. Am J Cardiol 1998; 81:1116.
  27. Sabharwal T, Manlhiot C, Benseler SM, et al. Comparison of factors associated with coronary artery dilation only versus coronary artery aneurysms in patients with Kawasaki disease. Am J Cardiol 2009; 104:1743.
  28. Newburger JW, Takahashi M, Burns JC, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 1986; 315:341.
  29. Son MB, Gauvreau K, Ma L, et al. Treatment of Kawasaki disease: analysis of 27 US pediatric hospitals from 2001 to 2006. Pediatrics 2009; 124:1.
  30. Nakamura Y, Yashiro M, Uehara R, et al. Use of laboratory data to identify risk factors of giant coronary aneurysms due to Kawasaki disease. Pediatr Int 2004; 46:33.
  31. Koren G, Lavi S, Rose V, Rowe R. Kawasaki disease: review of risk factors for coronary aneurysms. J Pediatr 1986; 108:388.
  32. Belay ED, Maddox RA, Holman RC, et al. Kawasaki syndrome and risk factors for coronary artery abnormalities: United States, 1994-2003. Pediatr Infect Dis J 2006; 25:245.
  33. Stockheim JA, Innocentini N, Shulman ST. Kawasaki disease in older children and adolescents. J Pediatr 2000; 137:250.
  34. Momenah T, Sanatani S, Potts J, et al. Kawasaki disease in the older child. Pediatrics 1998; 102:e7.
  35. Uehara R, Belay ED, Maddox RA, et al. Analysis of potential risk factors associated with nonresponse to initial intravenous immunoglobulin treatment among Kawasaki disease patients in Japan. Pediatr Infect Dis J 2008; 27:155.
  36. Manlhiot C, Yeung RS, Clarizia NA, et al. Kawasaki disease at the extremes of the age spectrum. Pediatrics 2009; 124:e410.
  37. Furusho K, Kamiya T, Nakano H, et al. High-dose intravenous gammaglobulin for Kawasaki disease. Lancet 1984; 2:1055.
  38. Yeo Y, Kim T, Ha K, et al. Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor. Eur J Pediatr 2009; 168:157.
  39. Shimizu C, Matsubara T, Onouchi Y, et al. Matrix metalloproteinase haplotypes associated with coronary artery aneurysm formation in patients with Kawasaki disease. J Hum Genet 2010; 55:779.
  40. Kariyazono H, Ohno T, Khajoee V, et al. Association of vascular endothelial growth factor (VEGF) and VEGF receptor gene polymorphisms with coronary artery lesions of Kawasaki disease. Pediatr Res 2004; 56:953.
  41. Onouchi Y, Gunji T, Burns JC, et al. ITPKC functional polymorphism associated with Kawasaki disease susceptibility and formation of coronary artery aneurysms. Nat Genet 2008; 40:35.
  42. Shimizu C, Jain S, Davila S, et al. Transforming growth factor-beta signaling pathway in patients with Kawasaki disease. Circ Cardiovasc Genet 2011; 4:16.
  43. Kato H, Sugimura T, Akagi T, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996; 94:1379.
  44. Takahashi M, Mason W, Lewis AB. Regression of coronary aneurysms in patients with Kawasaki syndrome. Circulation 1987; 75:387.
  45. Lin MT, Sun LC, Wu ET, et al. Acute and late coronary outcomes in 1073 patients with Kawasaki disease with and without intravenous γ-immunoglobulin therapy. Arch Dis Child 2015; 100:542.
  46. Friedman KG, Gauvreau K, Hamaoka-Okamoto A, et al. Coronary Artery Aneurysms in Kawasaki Disease: Risk Factors for Progressive Disease and Adverse Cardiac Events in the US Population. J Am Heart Assoc 2016; 5.
  47. Fujiwara T, Fujiwara H, Hamashima Y. Size of coronary aneurysm as a determinant factor of the prognosis in Kawasaki disease: clinicopathologic study of coronary aneurysms. Prog Clin Biol Res 1987; 250:519.
  48. Nakano H, Ueda K, Saito A, Nojima K. Repeated quantitative angiograms in coronary arterial aneurysm in Kawasaki disease. Am J Cardiol 1985; 56:846.
  49. Sugimura T, Kato H, Inoue O, et al. Intravascular ultrasound of coronary arteries in children. Assessment of the wall morphology and the lumen after Kawasaki disease. Circulation 1994; 89:258.
  50. Tsuda E, Kamiya T, Kimura K, et al. Coronary artery dilatation exceeding 4.0 mm during acute Kawasaki disease predicts a high probability of subsequent late intima-medial thickening. Pediatr Cardiol 2002; 23:9.
  51. Iemura M, Ishii M, Sugimura T, et al. Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function. Heart 2000; 83:307.
  52. Kurisu Y, Azumi T, Sugahara T, et al. Variation in coronary arterial dimension (distensible abnormality) after disappearing aneurysm in Kawasaki disease. Am Heart J 1987; 114:532.
  53. Matsumura K, Okuda Y, Ito T, et al. Coronary angiography of Kawasaki disease with the coronary vasodilator dipyridamole: assessment of distensibility of affected coronary arterial wall. Angiology 1988; 39:141.
  54. Sugimura T, Kato H, Inoue O, et al. Vasodilatory response of the coronary arteries after Kawasaki disease: evaluation by intracoronary injection of isosorbide dinitrate. J Pediatr 1992; 121:684.
  55. Suzuki A, Kamiya T, Kuwahara N, et al. Coronary arterial lesions of Kawasaki disease: cardiac catheterization findings of 1100 cases. Pediatr Cardiol 1986; 7:3.
  56. Kamiya T, Suzuki A, Ono Y, et al. Angiographic follow-up study of coronary artery lesion in the cases with a history of Kawasaki disease - with a focus on the follow-up more than ten years after the onset of the disease. In: Kawasaki Disease. Proceedings of the 5th International Kawasaki Disease Symposium, Kato H (Ed), Elsevier Science B.V., Amsterdam 1995. p.569.
  57. Tsuda E, Kamiya T, Ono Y, et al. Incidence of stenotic lesions predicted by acute phase changes in coronary arterial diameter during Kawasaki disease. Pediatr Cardiol 2005; 26:73.
  58. Newburger JW, Sanders SP, Burns JC, et al. Left ventricular contractility and function in Kawasaki syndrome. Effect of intravenous gamma-globulin. Circulation 1989; 79:1237.
  59. Printz BF, Sleeper LA, Newburger JW, et al. Noncoronary cardiac abnormalities are associated with coronary artery dilation and with laboratory inflammatory markers in acute Kawasaki disease. J Am Coll Cardiol 2011; 57:86.
  60. Moran AM, Newburger JW, Sanders SP, et al. Abnormal myocardial mechanics in Kawasaki disease: rapid response to gamma-globulin. Am Heart J 2000; 139:217.
  61. Selamet Tierney ES, Newburger JW, Graham D, et al. Diastolic function in children with Kawasaki disease. Int J Cardiol 2011; 148:309.
  62. Ravekes WJ, Colan SD, Gauvreau K, et al. Aortic root dilation in Kawasaki disease. Am J Cardiol 2001; 87:919.
  63. Ozdogu H, Boga C. Fatal cardiac tamponade in a patient with Kawasaki disease. Heart Lung 2005; 34:257.
  64. Kuppuswamy M, Gukop P, Sutherland G, Venkatachalam C. Kawasaki disease presenting as cardiac tamponade with ruptured giant aneurysm of the right coronary artery. Interact Cardiovasc Thorac Surg 2010; 10:317.
  65. Imai Y, Sunagawa K, Ayusawa M, et al. A fatal case of ruptured giant coronary artery aneurysm. Eur J Pediatr 2006; 165:130.
  66. Maresi E, Passantino R, Midulla R, et al. Sudden infant death caused by a ruptured coronary aneurysm during acute phase of atypical Kawasaki disease. Hum Pathol 2001; 32:1407.
  67. Tomita S, Chung K, Mas M, et al. Peripheral gangrene associated with Kawasaki disease. Clin Infect Dis 1992; 14:121.
  68. Tabarki B, Mahdhaoui A, Selmi H, et al. Kawasaki disease with predominant central nervous system involvement. Pediatr Neurol 2001; 25:239.
  69. Suda K, Matsumura M, Ohta S. Kawasaki disease complicated by cerebral infarction. Cardiol Young 2003; 13:103.
  70. Mele T, Evans M. Intestinal obstruction as a complication of Kawasaki disease. J Pediatr Surg 1996; 31:985.
  71. Akikusa JD, Laxer RM, Friedman JN. Intestinal pseudoobstruction in Kawasaki disease. Pediatrics 2004; 113:e504.
  72. Zulian F, Falcini F, Zancan L, et al. Acute surgical abdomen as presenting manifestation of Kawasaki disease. J Pediatr 2003; 142:731.
  73. Kahn AM, Budoff MJ, Daniels LB, et al. Calcium scoring in patients with a history of Kawasaki disease. JACC Cardiovasc Imaging 2012; 5:264.
  74. Kavey RE, Allada V, Daniels SR, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 2006; 114:2710.
  75. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011; 128 Suppl 5:S213.
  76. Selamet Tierney ES, Gal D, Gauvreau K, et al. Vascular health in Kawasaki disease. J Am Coll Cardiol 2013; 62:1114.
  77. Dietz SM, Tacke CE, Hutten BA, Kuijpers TW. Peripheral Endothelial (Dys)Function, Arterial Stiffness and Carotid Intima-Media Thickness in Patients after Kawasaki Disease: A Systematic Review and Meta-Analyses. PLoS One 2015; 10:e0130913.
  78. Dietz SM, Tacke CE, de Groot E, et al. Extracardial Vasculopathy After Kawasaki Disease: A Long-Term Follow-up Study. J Am Heart Assoc 2016; 5.
  79. Takahashi K, Oharaseki T, Naoe S. Pathological study of postcoronary arteritis in adolescents and young adults: with reference to the relationship between sequelae of Kawasaki disease and atherosclerosis. Pediatr Cardiol 2001; 22:138.
  80. Noto N, Okada T, Yamasuge M, et al. Noninvasive assessment of the early progression of atherosclerosis in adolescents with Kawasaki disease and coronary artery lesions. Pediatrics 2001; 107:1095.
  81. Cheung YF, Ho MH, Tam SC, Yung TC. Increased high sensitivity C reactive protein concentrations and increased arterial stiffness in children with a history of Kawasaki disease. Heart 2004; 90:1281.
  82. Mitani Y, Sawada H, Hayakawa H, et al. Elevated levels of high-sensitivity C-reactive protein and serum amyloid-A late after Kawasaki disease: association between inflammation and late coronary sequelae in Kawasaki disease. Circulation 2005; 111:38.
  83. Nakamura Y, Aso E, Yashiro M, et al. Mortality among persons with a history of kawasaki disease in Japan: mortality among males with cardiac sequelae is significantly higher than that of the general population. Circ J 2008; 72:134.
  84. McCrindle BW, McIntyre S, Kim C, et al. Are patients after Kawasaki disease at increased risk for accelerated atherosclerosis? J Pediatr 2007; 151:244.
  85. Gupta-Malhotra M, Gruber D, Abraham SS, et al. Atherosclerosis in survivors of Kawasaki disease. J Pediatr 2009; 155:572.
  86. Cheung YF, Yung TC, Tam SC, et al. Novel and traditional cardiovascular risk factors in children after Kawasaki disease: implications for premature atherosclerosis. J Am Coll Cardiol 2004; 43:120.
  87. Dhillon R, Clarkson P, Donald AE, et al. Endothelial dysfunction late after Kawasaki disease. Circulation 1996; 94:2103.
  88. Ooyanagi R, Fuse S, Tomita H, et al. Pulse wave velocity and ankle brachial index in patients with Kawasaki disease. Pediatr Int 2004; 46:398.
  89. Muzik O, Paridon SM, Singh TP, et al. Quantification of myocardial blood flow and flow reserve in children with a history of Kawasaki disease and normal coronary arteries using positron emission tomography. J Am Coll Cardiol 1996; 28:757.
  90. Mitani Y, Okuda Y, Shimpo H, et al. Impaired endothelial function in epicardial coronary arteries after Kawasaki disease. Circulation 1997; 96:454.
  91. Yamakawa R, Ishii M, Sugimura T, et al. Coronary endothelial dysfunction after Kawasaki disease: evaluation by intracoronary injection of acetylcholine. J Am Coll Cardiol 1998; 31:1074.
  92. Tsuda E, Hirata T, Matsuo O, et al. The 30-year outcome for patients after myocardial infarction due to coronary artery lesions caused by Kawasaki disease. Pediatr Cardiol 2011; 32:176.
  93. Kato H, Inoue O, Kawasaki T, et al. Adult coronary artery disease probably due to childhood Kawasaki disease. Lancet 1992; 340:1127.
  94. Rizk SR, El Said G, Daniels LB, et al. Acute myocardial ischemia in adults secondary to missed Kawasaki disease in childhood. Am J Cardiol 2015; 115:423.
  95. Tsuda E, Hamaoka K, Suzuki H, et al. A survey of the 3-decade outcome for patients with giant aneurysms caused by Kawasaki disease. Am Heart J 2014; 167:249.
  96. Tsuda E, Arakaki Y, Shimizu T, et al. Changes in causes of sudden deaths by decade in patients with coronary arterial lesions due to Kawasaki disease. Cardiol Young 2005; 15:481.
  97. Capannari TE, Daniels SR, Meyer RA, et al. Sensitivity, specificity and predictive value of two-dimensional echocardiography in detecting coronary artery aneurysms in patients with Kawasaki disease. J Am Coll Cardiol 1986; 7:355.
  98. Manlhiot C, Millar K, Golding F, McCrindle BW. Improved classification of coronary artery abnormalities based only on coronary artery z-scores after Kawasaki disease. Pediatr Cardiol 2010; 31:242.
  99. Crystal MA, Manlhiot C, Yeung RS, et al. Coronary artery dilation after Kawasaki disease for children within the normal range. Int J Cardiol 2009; 136:27.
  100. Dallaire F, Fournier A, Breton J, et al. Marked variations in serial coronary artery diameter measures in Kawasaki disease: a new indicator of coronary involvement. J Am Soc Echocardiogr 2012; 25:859.
  101. Colan SD. Normal echocardiographic values for cardiovascular structures, Appendix 1. In: Echocardiography in Pediatric and Congenital Heart Disease, Lai WW, Cohen MS, Geva T, Mertens L (Eds), Wiley-Blackwell, West Sussex, UK 2009. p.765.
  102. Parameter(z) Coronary Artery Z-Scores. Available at: http://www.parameterz.com/sites/coronary-arteries (Accessed on May 18, 2016).
  103. Ronai C, Baker AL, Friedman KG, et al. Prevalence of Undiagnosed Structural Heart Disease in Children Undergoing Echocardiography for Kawasaki Disease. Clin Pediatr (Phila) 2016; 55:557.
  104. Research Committee on Kawasaki Disease. Report of Subcommittee on Standardization of Diagnostic Criteria and Reporting of Coronary Artery Lesions in Kawasaki Disease. Ministry of Health and Welfare; Tokyo, Japan, 1984.
  105. JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2008)--digest version. Circ J 2010; 74:1989.
  106. Greil GF, Stuber M, Botnar RM, et al. Coronary magnetic resonance angiography in adolescents and young adults with kawasaki disease. Circulation 2002; 105:908.
  107. Danias PG, Stuber M, Botnar RM, et al. Coronary MR angiography clinical applications and potential for imaging coronary artery disease. Magn Reson Imaging Clin N Am 2003; 11:81.
  108. Mavrogeni S, Papadopoulos G, Douskou M, et al. Magnetic resonance angiography is equivalent to X-ray coronary angiography for the evaluation of coronary arteries in Kawasaki disease. J Am Coll Cardiol 2004; 43:649.
  109. Sohn S, Kim HS, Lee SW. Multidetector row computed tomography for follow-up of patients with coronary artery aneurysms due to Kawasaki disease. Pediatr Cardiol 2004; 25:35.
  110. Schmidt WA. Use of imaging studies in the diagnosis of vasculitis. Curr Rheumatol Rep 2004; 6:203.
  111. Han BK, Lesser A, Rosenthal K, et al. Coronary computed tomographic angiographic findings in patients with Kawasaki disease. Am J Cardiol 2014; 114:1676.
  112. Kondo C, Hiroe M, Nakanishi T, Takao A. Detection of coronary artery stenosis in children with Kawasaki disease. Usefulness of pharmacologic stress 201Tl myocardial tomography. Circulation 1989; 80:615.
  113. Jan SL, Hwang B, Fu YC, et al. Comparison of 201Tl SPET and treadmill exercise testing in patients with Kawasaki disease. Nucl Med Commun 2000; 21:431.
  114. Pahl E, Sehgal R, Chrystof D, et al. Feasibility of exercise stress echocardiography for the follow-up of children with coronary involvement secondary to Kawasaki disease. Circulation 1995; 91:122.
  115. Henein MY, Dinarevic S, O'Sullivan CA, et al. Exercise echocardiography in children with Kawasaki disease: ventricular long axis is selectively abnormal. Am J Cardiol 1998; 81:1356.
  116. Noto N, Ayusawa M, Karasawa K, et al. Dobutamine stress echocardiography for detection of coronary artery stenosis in children with Kawasaki disease. J Am Coll Cardiol 1996; 27:1251.
  117. Kimball TR, Witt SA, Daniels SR. Dobutamine stress echocardiography in the assessment of suspected myocardial ischemia in children and young adults. Am J Cardiol 1997; 79:380.
  118. Bezold LI, Lewin MB, Vick GW 3rd, Pignatelli R. Update on new technologies in pediatric echocardiography. Tex Heart Inst J 1997; 24:278.
  119. Mühling O, Jerosch-Herold M, Näbauer M, Wilke N. Assessment of ischemic heart disease using magnetic resonance first-pass perfusion imaging. Herz 2003; 28:82.
  120. Kaul S, Ito H. Microvasculature in acute myocardial ischemia: part I: evolving concepts in pathophysiology, diagnosis, and treatment. Circulation 2004; 109:146.
  121. Zilberman MV, Witt SA, Kimball TR. Is there a role for intravenous transpulmonary contrast imaging in pediatric stress echocardiography? J Am Soc Echocardiogr 2003; 16:9.
  122. Ishii M, Himeno W, Sawa M, et al. Assessment of the ability of myocardial contrast echocardiography with harmonic power Doppler imaging to identify perfusion abnormalities in patients with Kawasaki disease at rest and during dipyridamole stress. Pediatr Cardiol 2002; 23:192.
  123. Noto N, Kamiyama H, Karasawa K, et al. Long-term prognostic impact of dobutamine stress echocardiography in patients with Kawasaki disease and coronary artery lesions: a 15-year follow-up study. J Am Coll Cardiol 2014; 63:337.