Follow-up study of coronary artery bypass grafting in patients with Kawasaki disease.
BACKGROUND
The purpose of this study was to assess the long-term clinical outcome of coronary artery bypass grafting in pediatric patients with Kawasaki disease.


METHODS
Six patients (mean age, 9.3 +/- 1.6 years) underwent coronary artery bypass grafting between September 1985 and December 1992. The number of bypass grafts placed was 1 to 2 per patient (mean 1.3 +/- 0.5). The left internal mammary artery (IMA) was used as a bypass graft in 3 patients, bilateral IMA in 1, and saphenous vein in 3. All patients underwent postoperative evaluations after 1 month and between 5 and 10 years.


RESULTS
Follow-up ranged between 9 and 16 years (mean 12.6 +/- 2.7 years). Stress myocardial scintigraphy identified 2 patients with transient ischemia, one of whom died suddenly after 16 postoperative years. Coronary angiography demonstrated that the grafts of 5 patients were patent at both the short- and long-term follow-up. However, in 1 patient, the IMA that was grafted to the diagonal artery was occluded 1 month after surgery. Five survivors are in good health, without clinical angina.


CONCLUSIONS
We consider that coronary revascularization with bilateral IMA grafts may provide a more favorable prognosis in patients with severe Kawasaki coronary artery disease. Stress myocardial scintigraphy and echocardiography can be used effectively to follow such patients.
Inoue
T
T
Department of Cardiovascular Surgery, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan. rtc-ryo@med.kindai.ac.jp
Otaki
M
M
Oku
H
H
Fukuda
T
T
Shinohara
T
T
D000293:Adolescent; D000367:Age Factors; D002648:Child; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D004452:Echocardiography; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011379:Prognosis; D011877:Radionuclide Imaging; D012501:Saphenous Vein / Q000637:transplantation; D016896:Treatment Outcome