Surgical treatment of giant coronary artery aneurysm secondary to Kawasaki disease.
OBJECTIVE
To investigate the clinical features and surgical management of giant coronary artery aneurysm during end-stage Kawasaki disease.


METHODS
From May 2006 to October 2007, 5 patients, 2 to 57 years old, presented with giant coronary artery aneurysm and underwent surgical correction. The coronary aneurysm diameters were 1.5 to 2.5 cm. The coronary aneurysm lesion sites included the right main coronary artery in 1 case, the left main coronary artery in 2 cases, and both the left and right coronary arteries in 2 cases. Preoperative electrocardiogram revealed altered S-T segments in 5 cases and reduced ejection fraction values in 3 cases, resulting in 1 emergency admission for congestive heart failure. Surgical treatments included thromboendarterectomy, thrombectomy, and aneurysmal reconstruction under the orthophoria of extracorporeal circulation.


RESULTS
There were no operative deaths. All patients recovered and received dopamine 2 to 4 microg/min per kg and nitroglycerine 0.3 to 0.5 microg/min per kg. Time spent by patients in intensive care was uneventful. Following surgery, 4 patients showed ischemic improvement of the S-T segment on electrocardiograms, and 4 patients presented with increased ejection fraction, according to cardiac ultrasound inspection. The improvement of ejection fraction value was not significant in only 1 case.


CONCLUSIONS
Surgery is necessary for stage-3 Kawasaki disease patients that have giant coronary artery aneurysm complications. Surgical treatment includes thromboendarterectomy, thrombus clearing, aneurysmal reconstruction, and coronary artery bypass grafting, followed by postoperative anticoagulation and immunotherapy. Myocardial ischemia and cardiac function can be greatly improved through surgery.
Gu
Chunhu
C
Department of Cardiovascular Surgery, Fourth Military Medical University, Xi'an, Shanxi, China.
Fan
Shanhong
S
Zhou
Heping
H
Wang
Yunya
Y
Yi
Dinghua
D
Zhao
Rong
R
Sun
Guocheng
G
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003323:Coronary Aneurysm / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult