Coronary artery bypass graft surgery in a pediatric patient with a giant coronary aneurysm

Abstract

Kawasaki disease or mucocutaneous lymph node syndrome is an acute, febrile vasculitis of unknown etiology affecting mainly infants and children under five years of age. Coronary artery involvement, which occurs in approximately 20% of such patients, may be the most important feature of this syndrome. In this paper, we report a successful coronary artery bypass graft in a nine-year-old boy with a giant coronary artery aneurysm and diffuse coronary artery disease. Kawasaki disease (KD), previously known as mucocutaneous lymph node syndrome, is an acute, febrile, self-limiting generalized vasculitis of unknown etiology which occurs predominantly in infants and young children. It mainly affects small- and medium-sized arteries, particularly the coronary arteries, and was described by Kawasaki in 1967. (1) Gulhan et al. (2) reported a 42.4% incidence of coronary involvement in Turkish patients with KD. Kawasaki disease causes aneurysm formation at the proximal sites of the coronaries, while the distal sites are usually protected. Dilatation equal to or larger than 8 mm is categorized as a giant aneurysm, which may cause coronary artery stenosis secondary to compression or thrombosis. (3) Early diagnosis and rapid therapeutic interventions such as aspirin and intravenous gamma globulin may decrease the risk of coronary artery pathology development by approximately 20%. (4) In this paper, we present a successful coronary artery bypass grafting (CABG) in a boy who had one of the largest reported childhood coronary artery aneurysms to date.