[Coronary artery bypass after Kawasaki disease]

Area of Science:

• Pediatric Cardiology
• Rheumatology
• Systemic Vasculitis

Background:

• Kawasaki disease (KD) is a leading cause of acquired heart disease in children, potentially causing coronary artery aneurysms and ischemic heart disease.
• Early diagnosis and treatment with immunoglobulin and aspirin are standard for KD.
• Long-term sequelae may manifest years after initial presentation.

Observation:

• A teenage boy diagnosed with KD at age seven had normal acute-phase echocardiograms.
• At age eleven, he presented with chest pain and exertional dyspnea.
• Exercise nuclear perfusion scans indicated hypoperfusion in the left anterior descending and right coronary artery territories.

Findings:

• Cardiac catheterization revealed proximal occlusions in both the left anterior descending and right coronary arteries.
• The patient underwent successful coronary artery bypass graft surgery, including internal mammary artery to LAD and saphenous vein graft to RC.
• Surgical intervention resulted in a favorable clinical outcome.

Implications:

• This case underscores the critical need for vigilant, long-term cardiological follow-up in children with a history of Kawasaki disease.
• Delayed complications of KD, such as coronary artery occlusion, can occur despite initial normal cardiac assessments.
• Prompt recognition and management of late-onset cardiac issues are vital for preventing severe ischemic heart disease in pediatric patients.