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. 2020 Nov 22;4(6):1-7.
doi: 10.1093/ehjcr/ytaa390. eCollection 2020 Dec.

Bilateral internal thoracic artery grafting in children under 5 years of age with Kawasaki disease: a case series

Yusuke Shimahara  1 , Satsuki Fukushima  1 , Naoki Tadokoro  1 , Etsuko Tsuda  2 , Takaya Hoashi  3 , Soichiro Kitamura  1 , Junjiro Kobayashi  1 , Tomoyuki Fujita  1
Affiliations

Bilateral internal thoracic artery grafting in children under 5 years of age with Kawasaki disease: a case series

Yusuke Shimahara et al. Eur Heart J Case Rep. .

Abstract

Background: Although persistent coronary artery aneurysm of Kawasaki disease (KD) is rare, some patients develop a life-threatening myocardial infarction. In paediatric coronary artery bypass surgery (PCABS), the internal thoracic artery (ITA) graft is a reliable graft with favourable coronary outcomes. However, few studies have reported the outcomes and technical considerations of PCABS using bilateral ITAs in small children who have multivessel disease.

Case summary: We present the cases of three children under 5 years of age who underwent PCABS utilizing bilateral ITAs. All three patients had known bilateral giant coronary aneurysms associated with KD. Paediatric coronary artery bypass surgery was indicated after confirming multiple coronary lesions with myocardial ischaemia. One child underwent emergency PCABS because of circulatory collapse. The arterial anastomoses were performed under cardioplegic arrest. The left ITA was anastomosed to the left anterior descending artery (LAD) or the circumflex artery. The right ITA was anastomosed to the right coronary artery or the LAD. Post-operative coronary angiography revealed patent bilateral ITA grafts with an excellent run-off in all patients, and none of them have suffered any subsequent coronary event.

Discussion: Bilateral ITA grafting is a feasible procedure with favourable coronary outcomes for treating small children with multivessel disease, even in the setting of circulatory collapse.

Keywords: Bilateral internal thoracic artery grafting; Case report; Kawasaki disease; Paediatric coronary artery bypass surgery; Small children.

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Figures

Figure 1
Figure 1
(A) Pre-operative coronary angiography. Post-aneurysmal occlusion in the left anterior descending artery and the circumflex artery, and post-aneurysmal stenosis in the right coronary artery. Sparse opacification by the contrast medium in the left anterior descending artery and the circumflex artery. (B) Operative illustration. (C) Coronary angiography conducted 1 year post-operatively. Patent internal thoracic artery grafts with excellent run-off and nearly occluded coronary aneurysms.
Figure 2
Figure 2
(A) Pre-operative coronary angiography. Post-aneurysmal stenosis in the right coronary artery and critical post-aneurysmal stenosis with delayed opacification by the contrast medium in the left anterior descending artery. (B) Operative illustration. (C) Coronary angiography conducted 4 years post-operatively. Widely patent internal thoracic artery grafts with excellent run-off and occluded coronary aneurysms.
Figure 3
Figure 3
(A) Pre-operative coronary angiography. Post-aneurysmal occlusion in the left main coronary artery. Opacification of the left anterior descending artery and circumflex artery by the contrast medium from collaterals of the right coronary artery. (B) Operative illustration. (C) Coronary angiography conducted 1 month post-operatively. Patent internal thoracic artery grafts with excellent run-off.
None
See this image and copyright information in PMC

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