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[Coronary artery bypass grafting in a patient with Kawasaki disease]
S Fukunaga1, K Hisatomi, T Isomura
1Second Department of Surgery, Kurume University School of Medicine.
Insights
This study highlights the successful use of internal thoracic artery (ITA) bypass grafting in a young child with severe coronary artery disease secondary to Kawasaki disease. The procedure restored coronary blood flow, improving exercise capacity and offering a progressive surgical solution.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Rheumatology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children, often leading to coronary artery aneurysms and subsequent ischemic events.
- Severe coronary artery complications in KD, including myocardial infarction and heart failure, necessitate advanced treatment strategies.
- Early diagnosis and management of KD are crucial to prevent long-term cardiovascular sequelae.
Observation:
- A 3-year-old girl with a history of Kawasaki disease presented with angina at rest.
- Echocardiogram revealed coronary aneurysms at 3 months, followed by cardiac arrest and myocardial infarction at 4 months.
- Coronary angiography demonstrated total occlusion of the right coronary artery (RCA) and left anterior descending artery (LAD), with collateral filling of the LAD.
Findings:
- Coronary artery bypass grafting (CABG) to the LAD using the internal thoracic artery (ITA) was successfully performed in a 3-year-old girl.
- The ITA, measuring 1.2 mm in diameter, served as a viable conduit in this pediatric patient.
- Postoperative angiography confirmed excellent graft patency, and the patient showed improved exercise tolerance.
Implications:
- The internal thoracic artery (ITA) is a suitable conduit for coronary artery bypass grafting (CABG) even in very young children with complex coronary artery disease.
- ITA grafting offers a promising surgical option for the progressive management of cardiovascular complications arising from Kawasaki disease.
- This case underscores the importance of timely surgical intervention for pediatric patients experiencing severe ischemic heart disease due to coronary artery abnormalities.
Abstract:
A 3-year-girl admitted because of angina at rest. She had been diagnosed as Kawasaki disease at the age of 3 months. At that time, a coronary aneurysm was detected by echocardiogram and aspirin had started to administer. At the age of 4 months, a cardiac arrest occurred after severe heart attack because of inferior myocardial infarction. At the age of 2 years and 6 months, she started to complain of a chest pain even at rest. Coronary angiography was performed, and it showed total occlusion of RCA and LAD. However, LAD was vaguely filled by collateral flow from diagonal branch, and 201Tl scintigraphy showed myocardial viability of anteroseptal area. At operation, the size of ITA was 1.2 mm in diameter. Coronary artery bypass grafting to LAD by ITA was performed. Three weeks postoperatively, graft patency was confirmed by coronary angiography. The girl discharged with good ability of exercise. The ITA seemed to be the first choice of conduit for CABG even in a small child, and to be useful for progressive surgical treatment of Kawasaki disease.