title: Competition between native flow and graft flow after coronary artery bypass grafting. Impact on indications for coronary artery bypass grafting for localized stenosis with giant aneurysms due to Kawasaki disease.
abstract: We report the postoperative course of native and graft flow after coronary artery bypass grafting (CABG) in two patients with giant aneurysms and localized stenosis due to Kawasaki disease (KD). Although both patients had undergone CABG to the left anterior descending artery (LAD) with the left internal thoracic artery (ITA), at 5 and 10 years old, respectively, the ITA grafts were occluded 1 month postsurgery. However, when the two patients suffered complete occlusion of the native LAD more than 10 years after surgery, angiograms showed that the ITA grafts had reopened. We believe that this postoperative course reflects competition between the native artery flow and graft flow after CABG. CABG in patients with severely delayed coronary flows or recurrence of thrombus in giant aneurysms was ineffective in preventing myocardial infarction or damage. We conclude that CABG in giant aneurysm without significant localized stenosis should be avoided.
authors.affiliation: Department of Pediatrics, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita-shi, Osaka, 565-8565, Japan. etsuda@hsp.ncvc.go.jp
authors.forename: Etsuko
authors.initials: E
authors.lastname: Tsuda
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujita
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Yagihara
authors.forename: Osamu
authors.initials: O
authors.lastname: Yamada
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Echigo
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology*; D001807:Blood Vessel Prosthesis; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011184:Postoperative Period; D012720:Severity of Illness Index