Coronary artery bypass grafting for coronary aneurysms due to Kawasaki disease

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Rheumatology

Background:

• Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
• Coronary artery aneurysms (CAAs) are a common complication of KD, increasing the risk of myocardial infarction (MI).
• Surgical intervention for CAAs in KD typically addresses significant coronary stenosis.

Observation:

• A 23-year-old male with a history of KD presented with a second MI.
• Preoperative assessment revealed recurrent occlusion and recanalization of coronary artery flow without significant stenosis.
• The patient underwent coronary artery bypass grafting (CABG) using the left internal thoracic artery (LITA) and right gastroepiploic artery (RGEA).

Findings:

• This case highlights successful CABG in a patient with KD-associated CAAs and ischemic events, despite the absence of critical stenosis.
• The use of LITA and RGEA demonstrated feasibility for revascularization in this complex scenario.
• Repetitive occlusion and recanalization of coronary arteries indicate a dynamic process requiring intervention.

Implications:

• Coronary artery aneurysms alone, when associated with ischemic events, should be considered an indication for surgical intervention in Kawasaki disease.
• This expands the surgical indications beyond traditional coronary stenosis in KD patients.
• Further research may explore optimal surgical strategies and long-term outcomes for KD-associated CAAs without stenosis.