Abstract
Coronary artery bypass grafting (CABG) for severe cardiac sequelae of Kawasaki disease (KD) complicated by myocardial ischemia is feasible even in childhood. However, no report has summarized the prognosis of CABG in preschool-aged children. Therefore, we evaluated the outcomes of seven preschool-aged children who underwent CABG for the cardiac sequelae of KD in our hospital. The median age at KD onset and CABG was 36 and 59 months, respectively. The median period from KD onset to CABG was 12 months. The median post-operative observation period was 108 months. CABG between the left internal thoracic artery and left anterior descending artery was performed in all patients. In all patients, postoperative cardiac catheter examination revealed good graft patency and no anastomotic stenosis. Further, pre-operative abnormality of coronary flow reserve returned to normal after CABG. Currently, only one patient is taking warfarin. Regarding school–life management, no patient has exercise limitations, except for one patient who had acute myocardial infarction before CABG. Further, the risk of graft stenosis or occlusion was evaluated in the included patients. However, no accidents have been reported to date, and myocardial ischemia and school–life management have improved. Thus, CABG is an effective treatment in preschool-aged children.
Highlights
Published: 4 March 2022Kawasaki disease (KD) is a vasculitis of unknown cause that occurs in medium-sized systemic arteries
Coronary artery bypass grafting (CABG) in pediatric patients with KD has been established as a treatment for myocardial ischemia since Kitamura et al, performed it with a saphenous vein graft (SVG) in 1976 [2] and the internal thoracic artery (ITA) in 1985 [3]
We evaluated the outcomes in preschool-aged children who underwent CABG for the cardiac sequelae of KD
Summary
Kawasaki disease (KD) is a vasculitis of unknown cause that occurs in medium-sized systemic arteries. It commonly affects approximately 1-year old infants. Coronary artery bypass grafting (CABG) in pediatric patients with KD has been established as a treatment for myocardial ischemia since Kitamura et al, performed it with a saphenous vein graft (SVG) in 1976 [2] and the internal thoracic artery (ITA) in 1985 [3]. SVG is not used as a graft vessel because the patency rate of bypass grafts at postoperative 2 years is 67% for SVG and 93% for ITA [5]. Patients who underwent CABG with the ITA as a bypass graft had a patency rate of 91% at 15 years after surgery [5].
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