Department of Thoracic and Cardiovascular Surgery, Seoul National University 'Children's' Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Cardiol Young. 2022 Mar;32(3):459-464. doi: 10.1017/S1047951121002420. Epub 2021 Jul 2.
Although coronary artery bypass grafting is not frequently performed in children, Kawasaki disease is one of the most common indications for coronary artery bypass grafting in children. Here, we reviewed the long-term clinical outcomes including graft patency after coronary artery bypass grafting.
Between March 2004 and March 2013, six patients with Kawasaki disease underwent coronary artery bypass grafting. All patients were male. Their median age was 13.0 years (interquartile range, 7.8-17.8 years) at the timing of coronary artery bypass grafting, and the median age at the onset of Kawasaki disease was 3.3 years (interquartile range, 1.0-7.0 years). Four patients presented with multiple lesions including aneurysms.
The median follow-up duration was 12.1 years (interquartile range, 9.5-13.1 years), and there were no operative complications or overall mortality. One patient had pre-operative symptoms such as exertional chest pain and dyspnoea on exertion, whereas one patient had ventricular tachyarrhythmia. There was an improvement in subjective symptoms after surgery in two patients. The left internal thoracic artery, right internal thoracic artery, and saphenous vein were used in five (83.3%), one (16.7%), and two (33.3%) cases, respectively. In all six patients, post-operative single-photon emission CT findings showed improved perfusion compared with pre-operative single-photon emission CT. All grafts were patent as confirmed by coronary angiography or CT angiography.
Coronary artery bypass grafting could be a good surgical option in children with coronary lesions caused by Kawasaki disease in terms of graft patency and myocardial perfusion.
虽然儿童中很少进行冠状动脉旁路移植术，但川崎病是儿童冠状动脉旁路移植术最常见的适应证之一。在这里，我们回顾了长期临床结果，包括冠状动脉旁路移植术后的桥血管通畅情况。
2004 年 3 月至 2013 年 3 月，6 例川崎病患者接受了冠状动脉旁路移植术。所有患者均为男性。冠状动脉旁路移植术时的中位年龄为 13.0 岁（四分位距，7.8-17.8 岁），川崎病发病时的中位年龄为 3.3 岁（四分位距，1.0-7.0 岁）。4 例患者存在包括动脉瘤在内的多处病变。
中位随访时间为 12.1 年（四分位距，9.5-13.1 年），无手术并发症或总死亡率。1 例患者术前有劳力性胸痛和劳力性呼吸困难等症状，1 例患者有室性心动过速。2 例患者术后主观症状改善。5 例（83.3%）患者使用左内乳动脉、右内乳动脉和大隐静脉，1 例（16.7%）和 2 例（33.3%）患者分别使用了上述 2 种和 3 种桥血管。在所有 6 例患者中，术后单光子发射计算机断层扫描（SPECT）检查结果显示与术前相比灌注得到改善。冠状动脉造影或 CT 血管造影均证实所有桥血管通畅。
就桥血管通畅性和心肌灌注而言，冠状动脉旁路移植术可能是儿童川崎病冠状动脉病变的一种良好手术选择。
