Shimahara Yusuke, Fukushima Satsuki, Tadokoro Naoki, Tsuda Etsuko, Hoashi Takaya, Kitamura Soichiro, Kobayashi Junjiro, Fujita Tomoyuki
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
Department of Pediatric Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
Eur Heart J Case Rep. 2020 Nov 22;4(6):1-7. doi: 10.1093/ehjcr/ytaa390. eCollection 2020 Dec.
Although persistent coronary artery aneurysm of Kawasaki disease (KD) is rare, some patients develop a life-threatening myocardial infarction. In paediatric coronary artery bypass surgery (PCABS), the internal thoracic artery (ITA) graft is a reliable graft with favourable coronary outcomes. However, few studies have reported the outcomes and technical considerations of PCABS using bilateral ITAs in small children who have multivessel disease.
We present the cases of three children under 5 years of age who underwent PCABS utilizing bilateral ITAs. All three patients had known bilateral giant coronary aneurysms associated with KD. Paediatric coronary artery bypass surgery was indicated after confirming multiple coronary lesions with myocardial ischaemia. One child underwent emergency PCABS because of circulatory collapse. The arterial anastomoses were performed under cardioplegic arrest. The left ITA was anastomosed to the left anterior descending artery (LAD) or the circumflex artery. The right ITA was anastomosed to the right coronary artery or the LAD. Post-operative coronary angiography revealed patent bilateral ITA grafts with an excellent run-off in all patients, and none of them have suffered any subsequent coronary event.
Bilateral ITA grafting is a feasible procedure with favourable coronary outcomes for treating small children with multivessel disease, even in the setting of circulatory collapse.
尽管川崎病（KD）所致的持续性冠状动脉瘤较为罕见，但部分患者会发生危及生命的心肌梗死。在小儿冠状动脉搭桥手术（PCABS）中，胸廓内动脉（ITA）移植物是一种可靠的移植物，具有良好的冠状动脉治疗效果。然而，很少有研究报道在患有多支血管病变的小儿患者中使用双侧ITA进行PCABS的治疗效果及技术要点。
我们报告了3例5岁以下接受双侧ITA的PCABS患儿的病例。所有3例患者均已知患有与KD相关的双侧巨大冠状动脉瘤。在确认存在多处冠状动脉病变并伴有心肌缺血后，进行了小儿冠状动脉搭桥手术。1例患儿因循环衰竭接受了急诊PCABS。动脉吻合在心脏停搏下进行。左ITA吻合至左前降支动脉（LAD）或回旋支动脉。右ITA吻合至右冠状动脉或LAD。术后冠状动脉造影显示所有患者双侧ITA移植物均通畅，血流灌注良好，且均未发生任何后续冠状动脉事件。
双侧ITA移植对于治疗患有多支血管病变的小儿患者是一种可行的手术方法，即使在循环衰竭的情况下也具有良好的冠状动脉治疗效果。
