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Aortocoronary bypass surgery for coronary arterial lesions resulting from Kawasaki disease
Insights
Internal mammary artery grafts are effective for treating coronary artery lesions in children with Kawasaki disease. This surgery improves quality of life and life expectancy for affected patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Rheumatology
Background:
- Kawasaki disease frequently causes coronary artery aneurysms and stenosis in children.
- Coronary artery obstruction poses a significant risk for myocardial infarction and sudden death in pediatric patients.
- Aortocoronary bypass surgery is a potential intervention for severe coronary artery lesions in this population.
Purpose of the Study:
- To determine the indications and efficacy of aortocoronary bypass surgery for Kawasaki disease-induced coronary artery lesions.
- To evaluate the long-term outcomes of internal mammary artery (IMA) and saphenous vein (SV) grafts in pediatric patients.
- To assess the impact of surgery on myocardial function and coronary insufficiency.
Main Methods:
- Retrospective analysis of 26 pediatric patients (ages 1-17) who underwent aortocoronary bypass surgery.
- Follow-up included selective coronary arteriography, thallium myocardial imaging, and exercise stress tests.
- Surgical outcomes were compared using pre-operative, 1-month, and 1-year post-operative data.
Main Results:
- Graft patency rates at 1 year: 86% for IMA (22 grafts) and 67% for SV (9 grafts).
- Myocardial imaging showed improvement in 68% of patients at 1 month and further improvement in 29% by 1 year post-surgery.
- IMA grafts demonstrated sustained patency and contributed to improved coronary bed development.
Conclusions:
- Internal mammary artery grafts are a satisfactory option for managing coronary artery obstruction in Kawasaki disease.
- Aortocoronary bypass surgery can improve both the quality of life and life expectancy in affected children.
- Further investigation into the long-term benefits of IMA grafting in pediatric coronary artery disease is warranted.
Abstract:
To establish the indications for aortocoronary bypass surgery on coronary artery lesions caused by Kawasaki disease, we analyzed surgical outcome in 26 patients. Ages at operation ranged from 1 to 17 years. All patients were followed up with selective coronary arteriography, thallium myocardial imaging, electrocardiography at rest, and the Master "two-step" and treadmill exercise tests for coronary insufficiency. Surgical outcome was analyzed by comparing results of patient examinations made preoperatively with those both at 1 month and 1 year postoperatively. One month after the operation, 25 (93%) of 27 internal mammary artery grafts and 6 (86%) of 7 saphenous vein grafts were patent; 1 year after the operation, 19 (86%) of 22 internal mammary artery grafts and 6 (67%) of 9 saphenous vein grafts were patent. By comparing the preoperative findings of myocardial imaging with those obtained 1 month after surgery, we found that 17 (68%) of 25 showed improvement and 3 (12%) of 25 were worse. At 1 year, 6 (29%) of 21 showed further improvement than at 1 month, suggesting increased development of the coronary bed after internal mammary artery graft anastomosis. Thus an internal mammary artery graft has proved to be satisfactory in the management of children with coronary artery obstruction caused by Kawasaki disease; it appears that both the quality of life and the life expectancy of those patients can be improved by the surgery.