We describe our management of a 2-year-old patient with Kawasaki disease with a giant proximal right coronary artery (RCA) aneurysm and a >99% RCA ostial stenosis. After median sternotomy and cardioplegic arrest of the heart, we opened the aorta and cut into the RCA ostium past the stenosis and giant aneurysm. The RCA was reconstructed with an autologous pericardial patch. Cross-clamp and cardiopulmonary bypass times of 84 minutes and 114 minutes, respectively, were required. Our approach avoids mammary harvesting and grafting in such small patients while successfully treating ischemia and hopefully prevents further aneurysmal dilation over time.
KawasakiT.Infantile acute febrile mucocutaneous lymph node syndrome with specific desquamation of the fingers and toes. Clinical observation of 50 cases [in Japanese]. Jpn J Allerg. 1967;16(3):178–222.
4.
KawasakiTKosakiFOkawaS. A new infantile acute febrile mucocutaneous lymph node syndrome (MCLS) prevailing in Japan. Pediatrics. 1974;54(3):271–276.
5.
NewburgerJWTakahashiMGerberMA. Diagnosis, treatment, and long-term management of Kawasaki disease. A statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics. 2004;114(6):1708–171333.
6.
SuzukiAYamagishiMKimuraK. Functional behavior and morphology of the coronary artery wall in patients with Kawasaki disease assessed by intravascular ultrasound. J Am Coll Cardiol. 1996;27(2):291–296.
7.
OchiM. Review: surgical treatment of giant coronary aneurysms in pediatric patients with Kawasaki disease. Gen Thorac Cardiovasc Surg. doi:10.1007/s11748-017-0877-7.
8.
KitamuraS. Review: an new arena in cardiac surgery: pediatric coronary artery bypass surgery. Proc Jpn Acad Ser B Phys Biol Sci. 2018;94(1):1–19.
9.
MiyamotoTIkedaKIshiiYKobayashiT. Rupture of a coronary artery aneurysm in Kawasaki disease: a rare case and review of the literature for the past 15 years. J Thorac Cardiovasc Surg. 2014; 147(6):e67–e69.
10.
DionneABakloulMManlhiotC. Coronary artery bypass grafting and percutaneous coronary intervention after Kawasaki disease: the Pediatric Canadian Series. Pediatr Cardiol. 2017;38(1):36–43.
11.
JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease (JCS 2013). Digest version. Circ J. 2014;78(10):2521–2562. Epub 2014 Sep 22
12.
SepehripourAHHarlingLAshrafianHAthanasiouT. Pediatric Applications of Surgical Patch Angioplasty of the Main Coronary Trunks. World J Pediatr Congenit Heart Surg. 2014;5(2):283–290.
