Significance of Coronary Revascularization for Coronary-Artery Obstructive Lesions Due to Kawasaki Disease

Abstract

As an acquired ischemic heart disease in childhood, coronary-artery disease caused by Kawasaki disease (KD) has been known worldwide since the mid-1970s. KD patients who develop coronary-artery obstructive disease often need revascularization some time in their life. Coronary-artery revascularization for KD coronary lesions can be done with the surgical coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) procedures. However, the characteristics of coronary-arterial lesions caused by KD significantly differ from atherosclerotic coronary disease in adults. Therefore, it is much more difficult to determine the optimal time and selection of a coronary-artery revascularization procedure for KD sequelae. CABG using the internal thoracic artery has been accepted as a very useful and beneficial procedure since the mid-1980s, even in small children. Although the use of PCI in the late period can be effective in some adolescent and adult patients, the small vessel size and severe coronary-artery calcification are often limiting factors for its use in children. Therefore, CABG is a better approach for severe leftanterior descending artery and multiple-vessel disease in children and adolescents with KD coronary sequelae. Good coronary revascularization can improve the long-term outcomes of patients with severe KD complications.

Cardiac arrest, chronic total occlusion, and occluded stent in a 16-year-old boy with Kawasaki disease: a case report

“…Twenty-five year patency has been demonstrated at 87% with IMA grafts vs. 44% for vein grafts. 10 The IMA also deserves particular consideration in children, with its ability to grow in proportion to somatic growth allowing its use from an early age. 10 The same cannot be said for vein grafts or percutaneously placed stents.…”

Coronary Revascularization of Giant Aneurysms in Children With Kawasaki Disease: A Report of Two Cases

“…Subsequently, a study conducted in 1988 on 12 patients with LITA-LAD anastomoses reported a 100% patency rate, and the authors found that increases in the length and blood vessel diameter of the LITA paralleled the growth of the children ( 6 ). Recent literature includes reports of CABG involving the GEA, great saphenous vein, and radial artery bypass; most current cases involve the ITA, which is considered the optimal choice for use in bypass surgery in the majority of cases ( 7 – 10 ). Moreover, the use of the ITA requires anastomosis only with the coronary artery, and the minimal difference in the diameters of these vessels facilitates anastomosis.…”

Pediatric cardiothoracic vasculitis: multimodality imaging review

“…At the present time, both Kawasaki disease and Kawasaki-like MIS-C are managed similarly, with intravenous immunoglobulin (Ig) and moderate- to high-dose aspirin being the first-line treatments and potential adjuncts including corticosteroids as well as tumor necrosis factor, interleukin (IL)-1, and calcineurin inhibitors and other immunosuppressive agents [ 34 – 36 ]. Percutaneous coronary intervention and coronary artery bypass grafting are reserved for severe coronary disease, although with potentially improved outcomes [ 37 ].…”