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Coronary artery bypass graft in Kawasaki disease patients: Siriraj experience
Prakul Chanthong1, Somchai Sriyoschati, Kritvikrom Durongpisitkul
1Division of cardiology, Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand. prakul1@yahoo.com
Insights
Kawasaki disease can lead to serious heart problems in children. Coronary artery bypass graft surgery offers a safe and effective treatment for these complications, with promising early results.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Rheumatology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
- Acute KD complications include coronary artery aneurysms, which can lead to late issues like stenosis and myocardial insufficiency.
- Current treatments for severe sequelae include coronary artery bypass graft (CABG) and catheter interventions.
Purpose of the Study:
- To report the initial experience with CABG in pediatric patients suffering from KD-induced myocardial insufficiency.
- To evaluate the safety and efficacy of CABG in this specific pediatric population.
Main Methods:
- Retrospective case series of five pediatric patients with KD and myocardial insufficiency who underwent CABG.
- Surgical details, including graft choice (predominantly internal thoracic artery), were recorded.
- Postoperative outcomes and clinical courses were analyzed.
Main Results:
- The study included five patients aged 3.3 to 14.4 years.
- Two patients (40%) presented with angina.
- All patients experienced an uneventful postoperative course following CABG, with internal thoracic artery being the preferred graft.
Conclusions:
- Coronary artery bypass graft surgery is a safe and reliable option for managing coronary artery sequelae in children with Kawasaki disease.
- Further long-term follow-up is essential to ascertain the durability and long-term outcomes of bypass grafting in these patients.
Abstract:
Kawasaki disease (KD) is an acute systemic vasculitis. It is one of the most common acquired heart diseases in children. Its important acute complication is coronary artery aneurysm. Although most of these aneurysms resolved overtime but some never did. Coronary artery stenosis and myocardial insufficiency or infarction are late complications. Coronary artery bypass graft (CABG) and catheter intervention are the treatment for these patients. We report our first five cases of Kawasaki patients with myocardial insufficiency who underwent CABG at Siriraj Hospital. Patients' ages ranged from 3.3 to 14.4 years old. Only two patients (40%) had angina. Internal thoracic artery was used as a bypass graft in most patients and postoperative course was uneventful. Coronary bypass operation is a safe and reliable surgical modality for coronary artery sequelae in children with Kawasaki disease. A long-term follow-up is necessary to study the long-term outcome of bypass.
