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[Aorto-coronary bypass surgery for children with Kawasaki disease]
Insights
Aorto-coronary bypass surgery in children with Kawasaki disease showed good graft patency, particularly internal mammary artery grafts (IMAGs), leading to improved myocardial ischemia. Saphenous vein grafts (SVGs) had lower patency rates.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Rheumatology
Background:
- Kawasaki disease frequently causes coronary artery aneurysms and stenosis in children.
- Surgical intervention is sometimes necessary to restore coronary blood flow.
- Long-term outcomes of aorto-coronary bypass surgery in this population require evaluation.
Purpose of the Study:
- To evaluate the surgical outcomes of aorto-coronary bypass surgery in children with coronary artery lesions due to Kawasaki disease.
- To assess the patency of internal mammary artery grafts (IMAG) and saphenous vein grafts (SVG).
- To examine changes in regional myocardial ischemia post-surgery.
Main Methods:
- Retrospective analysis of 28 children undergoing aorto-coronary bypass surgery.
- Follow-up included coronary arteriography, thallium myocardial imaging, ECG, and exercise tests.
- Comparison of pre-operative and post-operative (1 month, 1 year, >3 years) findings.
Main Results:
- Internal mammary artery graft (IMAG) patency remained high (86-97%) at follow-up intervals.
- Saphenous vein graft (SVG) patency decreased significantly over time (43-86%).
- 50% of IMAGs showed improvement in myocardial ischemia at one month post-surgery.
Conclusions:
- Aorto-coronary bypass surgery, especially with IMAGs, can be effective in managing coronary artery lesions in children with Kawasaki disease.
- Long-term patency of SVGs is a concern, necessitating further investigation.
- Surgical technique and timing are critical factors for successful outcomes.
Abstract:
The results of aorto-coronary bypass surgery in 28 children with coronary artery lesions due to Kawasaki disease were evaluated. Ages at surgery ranged from one to 17 years, and the intervals from disease onset to surgery ranged from 2 months to 16.8 years. All patients were followed by selective coronary arteriography, thallium myocardial imaging, ECG at rest, and the Master double step and treadmill exercise tests. The surgical outcomes were analyzed by comparing the results of pre-operative examinations with those of one month, one year, and more than 3 year post-operative examinations. At one month, one year, and more than 3 year post-operative examinations, the incidences of patency of internal mammary artery graft (IMAG) were 29/30 (97%), 25/29 (86%), and 7/8 (88%), and those of patency of saphenous vein graft (SVG) were 6/7 (86%), 6/9 (67%), and 3/7 (43%), respectively. Three patients out of 4 who showed occlusion of their IMAGs within one year after surgery, and one deceased case apparently had problems related to the surgical procedures, such as the timing of surgery, reconstruction of the main trunk of coronary artery and the site of anastomoses between aneurysms. Pre-operative, one month, and one year post-operative thallium myocardial imagings were compared to examine the changes of regional myocardial ischemia in 24 children, and 28 IMAGs and 8 SVGs were evaluated. In the 28 IMAGs, 14/28 (50%) showed improvement of the myocardial ischemia, and 2/28 (7%) showed deterioration at one month follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)