Coronary Revascularization in Patients With Cardiac Sequelae of Kawasaki Disease at a Single Center

Abstract

Background: Kawasaki disease (KD) is a self-limited vasculitis that mainly affects infants and preschool-age children, characterized by coronary aneurysms and/or stenoses that may lead to the occurrence of ischemia, heart attack, and sudden death. This study aimed to evaluate the clinical and surgical results of pediatric patients with KD and cardiac sequelae who underwent coronary artery bypass grafting. Methods: A retrospective study was carried out. Patients with a diagnosis of KD and cardiac sequelae who underwent coronary artery bypass grafting from January 1, 2004, through March 31, 2021, were included: preoperative characteristics and conditions. Results: Ten patients were included, with a mean age of 6.4 ± 3.7 years; 80% males. Seven (70%) had the compromise of 2 coronary arteries, the most affected being the left anterior descendent artery (36.9%) with aneurysm and the right coronary artery (36.8%) with stenosis. 40% had preoperative moderate-to-severe ventricular dysfunction. The graft most frequently used was the right internal thoracic artery (47.6%), and the most frequent coronary bypass target vessel was the left anterior descending artery (38.1%). There was no early mortality or deaths during follow-up; 90% remained in functional class I. Among the cohort as a group, there was an overall improvement in postoperative ventricular function ( P = .03). This persisted, being unchanged at subsequent follow-up ( P = .95). Conclusions: Coronary artery bypass grafting is an appropriate treatment option for children with cardiac sequelae of KD, with excellent surgical results. Furthermore, this surgical procedure avoids the deterioration of left ventricular function in pediatric age.

Bibliometric and visual analysis of Kawasaki disease in children from 2012 to 2022

“…In the 25th national survey in Japan, CAD accounts for 6.52% of all types of complications, and 2.76% of patients are left with cardiovascular sequelae ( 54 ). The following pathological changes are seen in the arterial wall of the heart with a history of KD: inflammatory cell infiltration, destruction of the intima and media, the proliferation of intimal myofibroblasts, and replacement of myocytes by fibroblasts and connective tissue ( 55 ). Patients who develop CAA are at high risk for later coronary thrombotic or stenotic lesions, which may eventually progress to myocardial ischemia, infarction, or even death.…”