Coronary artery bypass grafting for Kawasaki disease
N Gotteiner1, C Mavroudis, C L Backer
1Department of Pediatrics, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL 60614, USA.
Insights
Coronary revascularization is a viable treatment for severe coronary artery abnormalities in children with Kawasaki disease. This study shows successful outcomes with no postoperative deaths and long-term graft patency in young patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Rheumatology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Coronary artery abnormalities, including stenosis and aneurysms, are common complications of KD.
- Severe coronary artery disease in pediatric patients may necessitate surgical intervention.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary revascularization in pediatric patients with severe coronary abnormalities secondary to Kawasaki disease.
- To assess long-term outcomes, including graft patency and patient symptomatology, following revascularization.
Main Methods:
- Retrospective review of five pediatric patients who underwent coronary revascularization between 1988 and 2000.
- Surgical indications included severe coronary artery stenosis, intracoronary thrombus, and ischemic events.
- Internal thoracic arteries were used for all revascularization procedures.
Main Results:
- No postoperative deaths occurred in the study cohort.
- All patients remained asymptomatic during follow-up periods ranging from 1 month to 11 years.
- One patient experienced late myocardial ischemia due to graft occlusion, successfully treated with percutaneous coronary angioplasty and stenting.
- One right internal thoracic artery graft involuted but the native vessel recannulated.
Conclusions:
- Coronary revascularization using internal thoracic arteries is a safe and effective treatment option for young patients with severe coronary abnormalities resulting from Kawasaki disease.
- Long-term graft patency is generally good, and revascularization can lead to sustained asymptomatic status.
Abstract:
Five patients with a history of Kawasaki disease underwent coronary revascularization at Children's Memorial Hospital (1988-2000). Acute disease occurred at 11 weeks to 5 years of age and revascularization procedures were performed at 8 months to 12 years (mean 6 years; interval from disease onset 5 months to 9 years). Surgical indications included abnormal stress testing with angiographic confirmation of severe coronary artery stenosis (n = 3), severe coronary artery stenosis with echocardiographic evidence of intracoronary thrombus (n = 1), and ischemic electrocardiogram changes and ventricular tachycardia during angiography (n = 1). All revascularization procedures used internal thoracic arteries including one free internal thoracic artery graft. There were no postoperative deaths (follow-up 1 month to 11 years). All patients are asymptomatic. One patient developed myocardial ischemia 4 years postoperatively with occlusion of the circumflex coronary artery (not previously grafted). This was treated successfully with percutaneous coronary angioplasty and stent placement. All grafts are patent with the exception of a single right internal thoracic artery graft which underwent involution 30 months postprocedure with concurrent recannulization of the right coronary artery. Coronary revascularization should be considered in the young patient with severe coronary abnormalities secondary to Kawasaki disease.
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