To assess the value of follow-up echocardiograms for patients with Kawasaki disease (KD). During a period of 5 years, children diagnosed with KD were enrolled in this study if at least three echocardiograms were documented, including one at admission, one at 1 to 2 months and one beyond 2 months following the onset of fever. The cohort study recruited 176 patients, and 120 patients were included in the final analysis. Most (116 patients, 97%) of the patients were under 5 years of age, and the male-to-female ratio was 1.93: 1. During the study period, KD was more common during the summer (35.8%). Of the 120 patients, 67 (56%) had normal echocardiograms, and 53 (44%) had abnormal echocardiograms at admission. Of the 53 patients with abnormal echocardiograms, 35 had coronary artery dilatation, and 18 had aneurysm. The mean interval between the onset of illness and the documentation of echocardiographic abnormality was 13 days (range 3-37 days). The abnormal echocardiographic findings resolved in 48 of the 53 (90%) patients in 2 years. No patient who had normal echocardiographic findings at 1-2 months developed subsequent abnormalities. There was no difference in the proportion of persistent abnormal follow-up echocardiographic findings in patients with initial coronary dilatation or aneurysm between the 2m-6m and 6m-12m follow-up echocardiograms (p = 0.78, p = 0.09, respectively). The proportion of patients with echocardiographic findings of coronary dilatation and aneurysm changed significantly between the 2m-6m and 12m-18m follow-up echocardiograms (p = 0.007, p = 0.045, respectively). Additional echocardiographic studies beyond 8 weeks for coronary artery morphology are not necessary if previous studies have produced normal results in patients with KD. Patients who have coronary artery abnormalities at the acute or subacute stage should receive an additional follow-up echocardiogram one year after the convalescent stage of the disease.