The Labatt Family Heart Centre, The Hospital for Sick Children and the University of Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2010 Feb;139(2):333-8. doi: 10.1016/j.jtcvs.2009.09.005. Epub 2009 Dec 14.
Pediatric coronary artery bypass grafting is uncommon. Small target vessels and appropriate conduit choice are the main technical challenges.
Fourteen patients undergoing coronary artery bypass grafting from January 1986 to December 2008 were retrospectively reviewed.
Median age was 10 years (range, 3-15 years); median weight was 36 kg (range, 12-71 kg). Indications included symptoms or evidence of inducible ischemia and angiographically documented coronary stenosis. Diagnoses included Kawasaki disease (5/14), anomalous left coronary artery originating from the pulmonary artery (2/14), previous stent implant (1/14), and metabolic disease (3/14). The remaining 3 patients had coronary stenosis after other cardiac operations. Preoperatively 5 patients (45%) had no symptoms and 9 (64%) had positive stress test. Single-vessel disease was demonstrated in 2 (14%), double-vessel disease in 7 (50%), triple-vessel disease in 1 (7%), and left main coronary artery involvement in 4 (29%). With standard cardiopulmonary bypass, 18 (81%) in situ internal thoracic arteries and 4 (19%) long saphenous veins were grafted. There was 1 early reoperation for graft failure. All patients survived to hospital discharge. Follow-up angiography was performed in 5 patients (36%; median, 2 years; range, 1 day-10 years), and 1 (7%) required late balloon dilatation. Median follow-up was 3.3 years (1 month-10 years), and 12 patients had no symptoms. There was 1 late death of noncardiac cause.
Pediatric coronary artery bypass grafting can be performed for a wide range of indications. Midterm results are excellent. Preoperative stress testing can detect silent myocardial ischemia.
小儿冠状动脉旁路移植术并不常见。小靶血管和适当的移植物选择是主要的技术挑战。
回顾性分析 1986 年 1 月至 2008 年 12 月期间 14 例接受冠状动脉旁路移植术的患者。
中位年龄为 10 岁（范围 3-15 岁）；中位体重为 36kg（范围 12-71kg）。适应证包括有症状或可诱导缺血的证据和血管造影证实的冠状动脉狭窄。诊断包括川崎病（5/14）、左冠状动脉异常起源于肺动脉（2/14）、先前支架植入（1/14）和代谢疾病（3/14）。其余 3 例患者在其他心脏手术后出现冠状动脉狭窄。术前 5 例（45%）无症状，9 例（64%）应激试验阳性。单支病变 2 例（14%），双支病变 7 例（50%），三支病变 1 例（7%），左主干病变 4 例（29%）。在标准体外循环下，18 例（81%）原位内乳动脉和 4 例（19%）大隐静脉进行了移植。有 1 例早期因移植物失败再次手术。所有患者均存活至出院。5 例（36%；中位数，2 年；范围，1 天-10 年）进行了随访血管造影，1 例（7%）需要晚期球囊扩张。中位随访时间为 3.3 年（1 个月-10 年），12 例患者无症状。有 1 例死于非心脏原因。
小儿冠状动脉旁路移植术可用于多种适应证。中期结果良好。术前应激试验可检测无症状性心肌缺血。
