Cardiac surgery of eight children with Kawasaki disease (Mucocutaneous lymph node syndrome).

Abstract

SUMMARYThe coronary arterial lesions of Kawasaki disease are characterized by multiple stenoses and aneurysms, which might lead to myocardial ischemia, myocardial infarction, mitral insufficiency due to ischemic papillary muscle dysfunction, ventricular aneurysm, etc.Eight children aged 6 to 13 years with Kawasaki disease underwent surgical treatments.These were coronary bypass surgery, coronary bypass surgery combined with right coronary aneurysmectomy and coronary bypass surgery combined with left ventricular aneurysmectomy.The postoperative course was smooth in all the patients. The selective angiography performed 1 month after the operation revealed the patency rate of 85% of the bypass grafts. However, 1 patient died suddenly during strenuous exercise 3 years after the surgery.Several points to be considered in the aortocoronary bypass in the patients with Kawasaki disease are discussed.These include the unknown fate of saphenous vein grafts and the possibility of higher incidences of graft failure in the growing children.Since the long-term postoperative results are as yet not fully understood, close follw-up of the patients treated by aortocoronary bypass surgery would be mandatory. 2) The symptoms of the disease are acute febrile conditions associated with hyperemia of the ocular conjunctiva, reddening of lips and oral and pharyngeal mucosa, indurative erythema of palms and soles, polymorphous exanthema on the trunk, swelling of the cervical lymph nodes,

Serious sequels of Kawasaki disease

“…Following discussion both locally and with international experts, a decision was made to treat our patient conservatively, awaiting either haemodynamic decompensation or the development of a malignant arrhythmia before considering possible resection of the aneurysm. 3 He will, however, be subjected to further investigations to ensure that additional areas of poor perfusion are not developing, which are suggestive of the development of coronary arterial stenosis and that may warrant further coronary angiography. There have been increasing reports of coronary bypass surgery in such affected children and adolescents with reasonable results.…”

Midterm outcomes of myocardial revascularization in children

“…15 During the last 4 decades, coronary origin anomalies have been treated successfully with a wide array of techniques, such as reimplantation, repair techniques, and CABG. 6,7,16 During the last 2 decades, the indications for CABG have expanded from Kawasaki disease and congenital anomalies to problems resulting from previous surgical procedures, such as correction of transposition of great arteries, or from failed percutaneous interventions.…”