Tsuda Etsuko, Kitamura Soichiro
Department of Pediatrics, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita-shi, Osaka, 565-8565, Japan.
Circulation. 2004 Sep 14;110(11 Suppl 1):II61-6. doi: 10.1161/01.CIR.0000138194.61225.10.
We surveyed the national experience of coronary artery bypass grafting (CABG) for coronary sequelae of Kawasaki disease (kDa) in 2002.
A questionnaire was returned from 323/552 (59%) institutions. Two hundred forty-four patients (188 male 56 female) since 1975 were identified. The mean number of grafts was 1.8 and the age at operation ranged from 1 to 44 years (median 11 years). The interval from the onset of kDa to operation ranged from 1 month to 42 years (median 8 years), whereas the follow-up period was from 7 days to 25 years (median 5 years). Previous myocardial infarction was found in 70 patients (28%). When the age at operation was older than 12 years, patency rates for internal thoracic artery grafts (ITA) at 1, 5, and 15 years were 95%, 91%, and 91%, respectively (n=156). When the age at operation was younger than 12 years, the corresponding values were significantly lower, with 1, 5, and 15 years being 93%, 73%, and 65%, respectively (n=146) (P<0.05). Reoperation was performed in 14 patients (6%). Death occurred in 15 patients (6%). Nine of the 14 late deaths were sudden. Six of 8 patients with a left ventricular ejection fraction (LVEF) <40% died.
The results of ITA in those aged 12 years or older were favorable. LVEF influenced prognosis.
我们于2002年调查了全国范围内川崎病（KD）冠状动脉后遗症行冠状动脉旁路移植术（CABG）的经验。
552家机构中有323家（59%）回复了问卷。确定了自1975年以来的244例患者（男188例，女56例）。平均移植血管数为1.8根，手术年龄为1至44岁（中位数11岁）。从KD发病到手术的间隔时间为1个月至42年（中位数8年），而随访时间为7天至25年（中位数5年）。70例患者（28%）曾有心肌梗死。手术年龄大于12岁时，胸廓内动脉移植血管（ITA）在1年、5年和15年时的通畅率分别为95%、91%和91%（n = 156）。手术年龄小于12岁时，相应数值显著较低，1年、5年和15年时分别为93%、73%和65%（n = 146）（P<0.05）。14例患者（6%）进行了再次手术。15例患者（6%）死亡。14例晚期死亡中有9例为猝死。左心室射血分数（LVEF）<40%的8例患者中有6例死亡。
12岁及以上患者的ITA结果良好。LVEF影响预后。
