Acute Kawasaki disease (KD) is diagnosed and treated by pediatricians, but decades later, these individuals are presenting to adult cardiologists with a variety of cardiovascular sequelae, including myocardial ischemia and infarction, congestive heart failure secondary to myocardial fibrosis, and claudication because of vascular insufficiency from thrombosed peripheral arteries. There are no clinical trials to guide management, interventions, and medical therapy in this patient population. This review summarizes the emerging information regarding evaluation of the cardiovascular status of adults decades after childhood KD.