Kitamura Soichiro, Tsuda Etsuko
National Cerebral and Cardiovascular Center, Department of Cardiovascular surgery, Suita,Osaka 565-8565, Japan.
National Cerebral and Cardiovascular Center, Department of Pediatric cardiology, Suita, Osaka 565-8565, Japan.
Children (Basel). 2019 Jan 29;6(2):16. doi: 10.3390/children6020016.
As an acquired ischemic heart disease in childhood, coronary-artery disease caused by Kawasaki disease (KD) has been known worldwide since the mid-1970s. KD patients who develop coronary-artery obstructive disease often need revascularization some time in their life. Coronary-artery revascularization for KD coronary lesions can be done with the surgical coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) procedures. However, the characteristics of coronary-arterial lesions caused by KD significantly differ from atherosclerotic coronary disease in adults. Therefore, it is much more difficult to determine the optimal time and selection of a coronary-artery revascularization procedure for KD sequelae. CABG using the internal thoracic artery has been accepted as a very useful and beneficial procedure since the mid-1980s, even in small children. Although the use of PCI in the late period can be effective in some adolescent and adult patients, the small vessel size and severe coronary-artery calcification are often limiting factors for its use in children. Therefore, CABG is a better approach for severe leftanterior descending artery and multiple-vessel disease in children and adolescents with KD coronary sequelae. Good coronary revascularization can improve the long-term outcomes of patients with severe KD complications.
作为一种儿童期获得性缺血性心脏病，川崎病（KD）所致冠状动脉疾病自20世纪70年代中期以来已为全球所知。发生冠状动脉阻塞性疾病的KD患者在其一生中的某个时候往往需要进行血运重建。KD冠状动脉病变的冠状动脉血运重建可通过外科冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）来完成。然而，KD所致冠状动脉病变的特征与成人动脉粥样硬化性冠状动脉疾病有显著差异。因此，确定KD后遗症冠状动脉血运重建手术的最佳时机和选择要困难得多。自20世纪80年代中期以来，使用胸廓内动脉进行CABG已被认为是一种非常有用且有益的手术，即使是在幼儿中。尽管在后期使用PCI对一些青少年和成年患者可能有效，但小血管尺寸和严重的冠状动脉钙化常常限制其在儿童中的应用。因此，对于患有KD冠状动脉后遗症的儿童和青少年，CABG是治疗严重左前降支动脉和多支血管疾病的更好方法。良好的冠状动脉血运重建可以改善严重KD并发症患者的长期预后。
