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Successful triple coronary artery bypass in a child with multiple coronary aneurysms due to Kawasaki's disease
Insights
Kawasaki disease can lead to severe coronary artery aneurysms and ischemia in children. Early surgical intervention, like coronary artery bypass grafting, can restore cardiac function and improve long-term outcomes.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Cardiovascular Surgery
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Coronary artery aneurysms are a serious complication, potentially leading to myocardial ischemia and infarction.
- Long-term sequelae require vigilant monitoring and management.
Observation:
- A 9-year-old girl presented with ischemic cardiac symptoms three years after initial Kawasaki disease diagnosis.
- Coronary angiography revealed multiple aneurysms in both right and left coronary arteries, with occlusion of the main vessels.
- Collateral circulation supported the myocardium, preventing acute myocardial infarction.
Findings:
- Severe coronary artery aneurysms and occlusion secondary to Kawasaki disease.
- Successful surgical revascularization using a triple saphenous vein bypass.
- Complete symptom resolution and normalization of cardiac function one year post-surgery.
Implications:
- Aggressive surgical management can be effective in treating complex coronary artery aneurysms in pediatric patients.
- Coronary artery bypass grafting offers a viable option for restoring coronary blood flow and improving quality of life.
- This case highlights the importance of long-term cardiovascular surveillance in Kawasaki disease survivors.
Abstract:
A 9-year-old girl developed ischemic cardiac symptoms 3 years after she first presented with characteristic manifestations of Kawasaki's disease, namely, high fever, conjunctivitis, lymphadenopathy, macular truncal skin rash, and erythema of both hands followed by desequamation of the skin of the fingertips. This acute illness resolved spontaneously within 2 weeks. Because of progressive and severe anginal symptoms and electrocardiographic signs of myocardial ischemia, she underwent cardiac catheterization and coronary angiography, which demonstrated multiple aneurysms of both right and left coronary artery systems. The two larger aneurysms of the right main and left main coronary arteries were clotted, causing complete occlusion of these vessels. Only collateral branches from the proximal right coronary artery which were supporting the entire coronary circulation, prevented her from having a myocardial infarction. A triple saphenous vein bypass was performed with excellent immediate results. One year later the patient was completely free of symptoms; she was living a normal life and a stress electrocardiogram was entirely normal.