Coronary artery bypass grafting in infants, children, and young adults for acquired and congenital lesions

Abstract

Coronary artery disease ranges from congenital in origin such as anomalous aortic origin of a coronary artery (AAOCA) to acquired diseases such as Kawasaki disease, and previously repaired conditions such as transposition of the great arteries. It is not uncommon, in the long run, for proximal coronary stenosis to develop following arterial switch, AAOCA repair, Ross procedure and Kawasaki disease leading to coronary artery bypass grafing (CABG). The objective of this report is to discuss the indications, challenges, and outcomes of CABG in infants, children, and young adults with acquired and congenital lesions.

Coronary artery bypass grafting in children

“…Other congenital procedures which may result in late CA stenosis include the Ross procedure and an aortic root replacement due to endocarditis …”

“…Some of the technical challenges of CABG in children include small target vessels, difficulties of exposure, and the availability of appropriate grafts. However, newborn and young infants have relatively large diameters of the internal thoracic and coronary arteries, which makes these arteries suitable for CABG, when indicated . Another concern is the long‐standing patency rate of the graft.…”

Isolated Congenital Coronary Ostial Stenosis in a Young Infant: A Case Report

“…5 Surgical treatment is the only therapeutic tool, considering the risk of sudden cardiac arrest. Coronary revascularization using internal mammary artery or saphenous vein as bypass grafts has been performed in infants and children, 2,6 but surgical coronary angioplasty is the preferred surgical technique as it avoids the risk of retrograde flow in the presence of intercoronary collaterals. 7 Surgical reconstruction of the left main coronary artery can be achieved using either autologous pericardium or saphenous vein patch; neither of them showed postoperative calcifications or aneurismal dilatation.…”

Emergency trans‐catheter coronary intervention for left main compression secondary to pulmonary hypertension in a 4‐year‐old child

“…Numerous therapeutic strategies including percutaneous coronary intervention (PCI), coronary bypass grafting, reparation of the congenital heart disease or lung‐heart transplantation were described in case reports of adults and young adults. There are only few reports about coronary bypass grafting in small kids . Percutaneous coronary intervention seems to be feasible and safe but no cases have been reported in a pediatric patient.…”

“…There are only few reports about coronary bypass grafting in small kids. [6][7][8][9] Percutaneous coronary intervention seems to be feasible and safe 10 but no cases have been reported in a pediatric patient. Limitations of PCI in this population are the small diameter of the LM and the unknown outcome of the PCI during child growth.…”