Objective: The most severe complication associated with giant coronary aneurysm in children with Kawasaki disease is ischemic cardiomyopathy (ICM) caused by thrombosis. Addition of tissue plasminogen activator, Alteplase, in the treatment regimen can be an efficient thrombolytic therapy, and therefore can have a significantly positive impact on patients’ quality of life in long term. Methods: Total four male KD patients with central thromboses in coronary aneurysm were treated in Pediatric Cardiology Department of Shengjing Hospital, China Medical University, from January 2020 to August 2021. These patients received thrombolytic treatments including Alteplase once + Heparin for 1 week followed by continuous oral Warfarin + Aspirin + Clopidogrel. Results: 4 young male KD patients had coronary aneurysm (CAA) complicated with total 7 occurrences of central thrombosis. These patients were given alteplase and heparin/oral Warfarin + Aspirin + Clopidogrel treatment. 9 days to 2 months later, thromboses were significantly dissolved. The treatment successfully diminished the thrombosis complication. Conclusion: 1. Pediatric KD patients complicated with coronary aneurysm thrombosis are prone to recurrence of thrombosis. 2. In KD patients complicated with coronary aneurysm thrombosis, treatments described in Method can be used for treating either small thromboses formed less than 1 month with strong echo and convex lumen or large thromboses with mixed strong and weak echo. With these treatments, coronary artery blood flow can be improved or completely recovered. 3. Clinical experiences at our center in treating these KD patients suggest that Alteplase can be considered in thrombolytic treatment beyond the limitation of less than 12 h of thrombosis occurrence.

Objectives: To investigate the level and clinical significance of soluble growth stimulation expressed gene 2 protein (sST2) in children with Kawasaki Disease (KD). Methods: A retrospective analysis was performed on 287 cases of KD in pediatric cardiology Department of Shengjing Hospital Affiliated to China Medical University from November 2021 to December 2022. They were grouped according to whether there was myocardial damage (MD), coronary artery damage (CAL), ≥3organs involved (MOD), and whether there was IVIG-R KD. In respective groups, the level of sST2 is correlated with WBC, HB, PLT, CRP, IL-6, ESR, NT-pro BNP, D-dimer, and ALB. Results: 1. They were younger and more male in CAL (P< 0.05). 2. In MD, CAL, MOD, and IVIG-R KD groups, the level of sST2, CRP, NT-pro BNP and D-dimer were higher than those negative group respectively (P< 0.05). 3. sST2 was weakly positively correlated with WBC, CRP, IL-6, NT-pro BNP and D-dimer, while weakly negatively correlated with HB and ALB (P< 0.05).4. sST2, HB and IL-6 were independent risk factors for MOD (P< 0.05). 5. sST2 and HB were independent risk factors for IVIG-R KD(P< 0.05). 6. In the acute cases, a totalof 4 cases had sST2 > 200ng/mL, all of which were IVIG-R KD and MOD, and among of them, 3 cases were combine with CAA. Conclusions: The level of sST2 was elevated in the acute phase of KD may indicate IVIG-R KD, CAA, MOD, and MD.