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. (Am Heart J 2001;142:740-4.)