Kawasaki disease (KD) is a febrile illness characterised by systemic inflammation of small- and medium-sized blood vessels, which commonly occurs in young children. Although self-limiting, there is a risk of developing coronary artery lesions as the disease progresses, with delay in diagnosis and treatment. Unfortunately, the diagnosis of KD continues to remain a clinical dilemma. Thus, this article not only summarises the key research gaps associated with KD, but also evaluates the possibility of using circulating endothelial injury biomarkers, such as circulating endothelial cells, endothelial microparticles and vascular endothelial cell-free DNA, as diagnostic and prognostic tools for KD: a “liquid biopsy” approach. The challenges of translating liquid biopsies to use in KD and the opportunities for improvement in its diagnosis and management that such translation may provide are discussed. The use of endothelial damage markers, which are easily obtained via blood collection, as diagnostic tools is promising, and we hope this will be translated to clinical applications in the near future.

Introduction: Cyanotic congenital heart disease with duct-dependent pulmonary blood flow requires initial palliation before definitive repair. Traditionally, these were surgical systemic-to-pulmonary shunts (SPS) such as the modified Blalock-Taussig-Thomas shunt. Transcatheter procedures are recently emerging as alternative options. Previous reviews have compared ductal stenting (DS) or right ventricular outflow tract (RVOT) intervention to surgical SPS, but none compared all three strategies in a single meta-analysis.Methods: We performed a systematic review and network meta-analysis for a three-way comparison of DS, RVOT intervention, and surgical SPS as initial palliation in children aged 0–3 with cyanotic congenital heart disease. Primary outcomes were mortality rates, complication rates, and re-intervention rates. MEDLINE, EMBASE, and Cochrane databases were searched for publications from 2003 to 2023. References of previous systematic reviews were screened.Results: Twenty publications were included for analysis, for a total of 4,441 patients. Transcatheter options consistently ranked superior to surgical SPS for Early and Overall Mortality. DS also outperformed surgical SPS for Procedural Complications. Surgical SPS was worst for Early Re-interventions, but outperforms both transcatheter options for Overall Re-interventions and Intra-procedural Mortality. Both DS and RVOT stenting conferred a shorter overall hospitalization duration compared to surgical SPS, and DS also gave a shorter length of stay in intensive care compared to surgical SPS.Conclusions: Transcatheter options are viable, safe, and attractive alternatives to traditional surgical shunts in the treatment of duct-dependent cyanotic heart disease. With wider adoption, increased collective expertise will help to further improve patient outcomes of these less-invasive techniques.Systematic Review Registration: PROSPERO (CRD42024489748).

Kawasaki disease is a febrile illness characterised by systemic inflammation of small- and medium-sized blood vessels which commonly occurs in young children. Although self-limiting, there is a risk of developing coronary artery lesions as disease progresses with delay in diagnosis and treatment. Unfortunately, the diagnosis of KD continues to remain a clinical dilemma. Thus, this article not only summarises the key research gaps associated to KD, but also evaluates the possibility of using circulating endothelial injury biomarkers such as, circulating endothelial cells, endothelial microparticles and vascular endothelial cell-free DNA, as diagnostic and prognostic tool of KD: a “liquid biopsy” approach. The challenges of translating liquid biopsies to use in KD, and the opportunities for improvement in its diagnosis and management that such translation may provide are discussed. The use of endothelial damage markers, which are easily obtained via blood collection, as diagnostics is promising and we hope this will be translated to clinical applications in the near future.