Hirose H, Kawashima Y, Nakano S, Matsuda H, Sakakibara T, Hiranaka T, Imagawa H, Ogawa M, Harima R
Circulation. 1986 Sep;74(3 Pt 2):I77-81.
Problems in myocardial revascularization for coronary impairment due to Kawasaki disease were assessed in five patients 1 to 4 years old. Each patient had significant stenosis or complete obstruction with aneurysm formation. There were no operative or late deaths in the follow-up period of 1 to 10 years after operation. The coronary arteries, including the first diagonal branch and obtuse marginal branch, were 1 to 1.5 mm in diameter. Eight saphenous vein grafts used were 2.5 to 3.5 mm in diameter and the internal mammary arteries used in two patients, ages 2 and 4 years, were 1 mm in diameter. All nine grafts examined in the early postoperative period were patent. However, only three of eight saphenous vein grafts were patent in the late postoperative studies. One saphenous vein graft to the right coronary artery was found patent 7 years after surgery in a patient who had been operated on at the age of 3 years. Internal mammary artery grafts used in the last two patients in the series were both patent throughout the late postoperative period. This experience suggests that myocardial revascularization is surgically feasible and beneficial even in young children and that further study is warranted.
对5例1至4岁因川崎病导致冠状动脉损伤而行心肌血运重建的患儿进行了评估。每例患儿均有明显狭窄或伴有动脉瘤形成的完全阻塞。术后1至10年的随访期内无手术死亡或晚期死亡病例。包括第一对角支和钝缘支在内的冠状动脉直径为1至1.5毫米。使用的8条大隐静脉移植血管直径为2.5至3.5毫米，2例年龄分别为2岁和4岁患儿使用的乳内动脉直径为1毫米。术后早期检查的所有9条移植血管均通畅。然而，术后晚期研究中8条大隐静脉移植血管仅有3条通畅。在1例3岁时接受手术的患儿中，1条移植至右冠状动脉的大隐静脉移植血管在术后7年仍通畅。该系列最后2例患儿使用的乳内动脉移植血管在术后晚期均一直保持通畅。这一经验表明，即使对于幼儿，心肌血运重建在手术上也是可行且有益的，有必要进一步开展研究。
