Connolly Michelle J, Khan Sarosh, Li Kam Wa Matthew E, Faircloth Matthew E, Clapp Brian
Department of Cardiology, Atkinson-Morley Wing, St George's Hospital, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK.
St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, UK.
Eur Heart J Case Rep. 2020 Nov 4;4(6):1-5. doi: 10.1093/ehjcr/ytaa289. eCollection 2020 Dec.
Kawasaki disease is the leading cause of premature coronary artery disease in developed countries. As such, patients may require revascularisation as children. However, there are no randomized data guiding treatment so this must be individualized. This case report describes the decision-making in a young patient requiring revascularization who had already suffered stent occlusion.
Our patient, a 16-year-old boy with Kawasaki disease, presented with cardiac arrest during exercise. Coronary angiography showed that a proximal left anterior descending artery stent implanted at the age of 8 years had occluded some time ago and his right coronary artery was also chronically occluded. He has discussed in several Heart Team meetings and with international colleagues and a consensus reached to revascularize him surgically.
It is vital that young patients with complex coronary disease are discussed in an extensive multidisciplinary setting to determine the most suitable means of treatment. The previously occluded stent was crucial in the individualized decision-making in this patient.
川崎病是发达国家儿童期冠状动脉疾病过早发生的主要原因。因此，患者在儿童期可能就需要进行血运重建。然而，目前尚无指导治疗的随机数据，所以治疗必须个体化。本病例报告描述了一名年轻患者在已经发生支架闭塞的情况下进行血运重建的决策过程。
我们的患者是一名16岁患川崎病的男孩，在运动时发生心脏骤停。冠状动脉造影显示，其8岁时植入的左前降支近端支架已于此前某个时间发生闭塞，右冠状动脉也存在慢性闭塞。已经在多次心脏团队会议上对该病例进行了讨论，并与国际同行进行了交流，最终达成共识，通过手术为他进行血运重建。
对于患有复杂冠状动脉疾病的年轻患者，在广泛的多学科环境中进行讨论以确定最合适的治疗方法至关重要。之前闭塞的支架在该患者的个体化决策中起到了关键作用。
