Coronary artery bypass grafting in a child with Kawasaki disease
Pedro Magro1, Nuno Carvalho2, Rui Anjos2
1Department of Cardiothoracic Surgery, Santa Cruz Hospital, Carnaxide, Portugal.
Insights
This case study highlights successful coronary artery bypass grafting in a young child with severe coronary artery aneurysms resulting from Kawasaki disease (KD). The surgery effectively addressed complex coronary sequelae when standard treatments were not feasible.
Area of Science:
- Cardiology
- Pediatric Surgery
Background:
- Kawasaki disease (KD) can lead to serious cardiac complications, including coronary artery aneurysms, stenosis, and thrombosis.
- Early diagnosis and treatment of KD are crucial to prevent long-term cardiovascular sequelae.
Observation:
- A 23-month-old male diagnosed late with KD, who was not a candidate for intravenous immunoglobulin therapy.
- Echocardiography revealed significant coronary artery abnormalities at age five, including large aneurysms and severe stenosis in the anterior descending and right coronary arteries.
Findings:
- Angiography confirmed a 17 mm×7 mm aneurysm of the anterior descending coronary artery with 90% stenosis and a 32 mm×6 mm aneurysm of the right coronary artery.
- Coronary artery bypass grafting using an internal mammary artery graft under cardiopulmonary bypass was performed due to the critical anatomy of the anterior descending artery.
- The patient experienced no significant intraoperative or postoperative complications.
Implications:
- Coronary artery bypass grafting is a viable and effective treatment for complex coronary sequelae of Kawasaki disease, even in very young children.
- This case underscores the importance of surgical intervention for managing severe cardiovascular manifestations of KD when other treatments are contraindicated or ineffective.
- Long-term follow-up is essential for patients with coronary artery aneurysms secondary to Kawasaki disease.
Abstract:
Kawasaki disease (KD) with cardiac involvement can result in the development of coronary aneurysm, stenosis or thrombosis with significant cardiovascular implications. We report the case of a 23-month-old male with a late diagnosis of KD, in whom intravenous immunoglobulin treatment was not feasible. The patient's course was assessed by routine echocardiography. At the age of five years, angiographic assessment revealed an aneurysm of the anterior descending coronary artery measuring 17 mm×7 mm involving the first diagonal branch, 90% post-aneurysmal stenosis, and an aneurysm of the right coronary artery measuring 32 mm×6 mm. Due to the critical anatomy of the anterior descending artery the revascularization method of choice was coronary artery bypass surgery with an internal mammary artery graft, under cardiopulmonary bypass. There were no significant intraoperative or postoperative complications. This confirms coronary artery bypass grafting as a reliable treatment option for patients who present with coronary sequelae from KD, even at a very young age.
