**12. Functional assessment**

Cardiac stress testing may be used to identify reversible ischaemia and regional wall motion abnormalities during increased demand. Coronary perfusion abnormalities can be further assessed with exercise echocardiography, pharmacologic (dobutamine, dipyridamole or adenosine) stress echocardiography and exercise myocardial perfusion scans. The stress modality employed depends on the age of the child and local expertise, although practically speaking, pharmacologic stress echocardiography or exercise myocardial perfusion scans are the preferred techniques in the paediatric age group. If abnormalities of coronary segmental perfusion are found, the results may assist decisionmaking for further management.

Echocardiography in Kawasaki Disease 149

Fig. 9. Lateral angiographic plane with injection of contrast in the ascending aorta via a pigtail catheter, showing large saccular aneurysms in both the proximal right and left coronary arteries. (Image courtesy of Professor Mike South, Royal Children's Hopsital, Melbourne)

The percentage of patients developing coronary aneurysms is reduced with timely administration of intravenous immunoglobulin. Nearly 50% of those coronary artery aneurysms will show angiographic regression within 1 to 2 years following the illness, with smaller lesions having a greater chance of resolution (Newburger et al., 2004). The size of the aneurysm is a major predictor for the development of myocardial infarction (Yeu et al., 2008). As aneurysms remodel with time, however, the risk of coronary artery

**14. Natural history** 

stenosis increases.
