Journal of Shandong University (Health Sciences) ›› 2025, Vol. 63 ›› Issue (5): 47-53.doi: 10.6040/j.issn.1671-7554.0.2024.0809

• Special Topic on Application of Arterial Grafts in Coronary Artery Bypass Grafting • Previous Articles    

Total arterial coronary artery bypass grafting for treatment of coronary artery aneurysm after Kawasaki disease in a child: case report and literature review

WANG Zhiqi1, QI Jirong1, HU Yuanli1, CHEN Xujun2, WANG Qingfeng1, MO Xuming1   

  1. 1. Department of Cardiothoracic Surgery, Childrens Hospital of Nanjing Medical University, Nanjing 210019, Jiangsu, China;
    2. Cardiovascular Surgery, Wuhan NO.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
  • Published:2025-05-07

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Abstract: Objective To investigate the advantages of using the radial artery as a conduit in adolescent CABG by reporting the treatment of a child with a giant coronary artery aneurysm complicating Kawasaki disease who underwent total arterial coronary artery bypass grafting(CABG)and to review relevant literature. Methods A case of a 13-year-old male with a coronary artery aneurysm secondary to Kawasaki disease was reviewed. The child developed a large coronary artery aneurysm as a complication of Kawasaki disease. CABG was performed using bilateral radial arteries as grafts. Results Postoperative recovery was uneventful, with patency of the grafts and significant improvement in cardiac function. Conclusion Coronary artery aneurysms caused by Kawasaki disease are a leading cause of acquired heart disease in children. CABG plays a critical role in treating giant coronary aneurysms. The selection of arterial grafts is crucial for ensuring survival and optimal outcomes.

Key words: Kawasaki disease, Coronary artery aneurysm, Coronary artery bypass grafting, Radial artery

CLC Number: 

  • R654
[1] Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children[J]. Arerugi, 1967, 16(3): 178-222.
[2] McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American heart association[J]. Circulation, 2017, 135(17): e927-e999.
[3] Makino N, Nakamura Y, Yashiro M, et al. Nationwide epidemiologic survey of Kawasaki disease in Japan, 2015-2016[J]. Pediatr Int, 2019, 61(4): 397-403.
[4] 中华医学会儿科学分会心血管学组, 中华医学会儿科学分会免疫学组. 川崎病冠状动脉病变的临床处理建议[J]. 中华儿科杂志, 2012, 50(10): 746-749. The Subspecialty Group of Cardiology, The Society of Pediatrics, Chinese Medical Association; The Subspecialty Group of Immunology, The Society of Pediatrics, Chinese Medical Association. Recommendations for clinical management of Kawasaki disease with coronary arterial lesions [J]. Chinese Journal of Pediatrics, 2012, 50(10): 746-749.
[5] Newburger JW, Takahashi M, Beiser AS, et al. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome[J]. N Engl J Med, 1991, 324(23): 1633. doi:10.1056/NEJM199106063242305
[6] Orenstein JM, Shulman ST, Fox LM, et al. Three linked vasculopathic processes characterize Kawasaki disease: a light and transmission electron microscopic study[J]. PLoS One, 2012, 7(6): e38998. doi:10.1371/journal.pone.0038998
[7] Varol F, Dedeo glu R, Kiliç A, et al. Retrospective analysis of children diagnosed with Kawasaki disease[J]. Turk J Med Sci, 2023, 53(4): 979-989.
[8] Santimahakullert K, Vijarnsorn C, Wongswadiwat Y, et al. A retrospective cohort study of major adverse cardiac events in children affected by Kawasaki disease with coronary artery aneurysms in Thailand[J]. PLoS One, 2022, 17(1): e0263060. doi:10.1371/journal.pone.0263060.
[9] 熊祎, 张永兰, 杜忠东. 川崎病合并巨大冠状动脉瘤101例中长期随访[J]. 中华儿科杂志, 2021, 59(2): 101-106. XIONG Yi, ZHANG Yonglan, DU Zhongdong. Middle and long-term follow-up of 101 children with giant coronary artery aneurysm of Kawasaki disease[J]. Chinese Journal of Pediatrics, 2021, 59(2): 101-106.
[10] Samada K, Shiraishi H, Sato A, et al. Grown-up Kawasaki disease patients who have giant coronary aneurysms[J]. World J Pediatr, 2010, 6(1): 38-42.
[11] Tsuda E, Hamaoka K, Suzuki H, et al. A survey of the 3-decade outcome for patients with giant aneurysms caused by Kawasaki disease[J]. Am Heart J, 2014, 167(2): 249-258.
[12] 罗凯, 郑景浩, 何晓敏, 等. 儿童期川崎病并发冠状动脉瘤外科治疗初步探究[J]. 中华小儿外科杂志, 2021, 42(12): 1066-1071. LUO Kai, ZHENG Jinghao, HE Xiaomin, et al. Preli-minary study on surgical treatment for children complicated with Kawasaki disease and coronary artery aneurysm[J]. Chinese Journal of Pediatric Surgery, 2021, 42(12): 1066-1071.
[13] 高文卿, 李彤, 胡晓旻, 等. 冠状动脉移植术后患者桥血管通畅情况观察[J]. 天津医药, 2018, 46(7): 696-699. GAO Wenqing, LI Tong, HU Xiaomin, et al. Observation on patency of radial artery bridge in patients after coronary artery transplantation[J]. Tianjin Medical Journal, 2018, 46(7): 696-699.
[14] Zhang XL, Zhu QQ, Yang JJ, et al. Percutaneous intervention versus coronary artery bypass graft surgery in left main coronary artery stenosis: a systematic review and meta-analysis[J]. BMC Med, 2017, 15(1): 84. doi:10.1186/s12916-017-0853-1
[15] 刘志刚, 刘晓程, 何国伟. 不同部位的人体冠状动脉搭桥材料血管释放一氧化氮和内皮超极化因子差异的实验研究[J]. 中国循环杂志, 2011, 26(6): 430-433. LIU Zhigang, LIU Xiaocheng, HE Guowei. The diffe-rences of endothelium-derived nitric oxide and hyperpolarizing factor among human internal mammary artery, radial artery and saphenous vein[J]. Chinese Circulation Joumal, 2011, 26(6): 430-433.
[16] Al-Bustami MH, Amrani M, Chester AH, et al. In vivo early and mid-term flow-mediated endothelial function of the radial artery used as a coronary bypass graft[J]. J Am Coll Cardiol, 2002, 39(4): 573-577.
[17] Ikeda M, Ohashi H, Tsutsumi Y, et al. Angiographic evaluation of the luminal changes in the radial artery graft in coronary artery bypass surgery: a concern over the long-term patency[J]. Eur J Cardiothorac Surg, 2002, 21(5): 800-803.
[18] 陈绪军, 张建, 李伟栋, 等. 2023年欧洲心胸外科协会和美国胸外科医师协会《冠状动脉旁路移植术旁路血管选择专家共识》解读[J]. 中华外科杂志, 2024, 62(1): 44-48. CHEN Xujun, ZHANG Jian, LI Weidong, et al. Interpretation on Expert systematic review on the choice of conduits for coronary artery bypass grafting endorsed by the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons in 2023[J]. Chinese Journal of Surgery, 2024, 62(1): 44-48.
[19] Tatoulis J. The radial artery: an important component of multiarterial coronary surgery and considerations for its optimal harvest[J]. JTCVS Tech, 2021, 5: 46-55. doi:10.1016/j.xjtc.2020.10.042
[20] 陈绪军, 郑宝石, 张永, 等. 冠状动脉旁路移植术双桡动脉桥多中心应用的中期结果[J]. 中华医学杂志, 2019, 99(14): 1069-1074. CHEN Xujun, ZHENG Baoshi, ZHANG Yong, et al. Mid-term multi-center outcomes of bilateral radial artery as conduits in coronary artery bypass grafting[J]. National Medical Journal of China, 2019, 99(14): 1069-1074.
[21] Carpentier A, Guermonprez JL, Deloche A, et al. The aorta-to-coronary radial artery bypass graft. A technique avoiding pathological changes in grafts[J]. Ann Thorac Surg, 1973, 16(2): 111-121.
[22] Tatoulis J, Royse AG, Buxton BF, et al. The radial artery in coronary surgery: a 5-year experience: clinical and angiographic results[J]. Ann Thorac Surg, 2002, 73(1): 143-147.
[23] 陈绪军, 郑宝石, 邢万红, 等. 冠状动脉旁路移植术多支动脉桥应用的若干热点问题[J]. 中华医学杂志, 2019, 99(14): 1048-1052. CHEN Xujun, ZHENG Baoshi, XING Wanhong, et al. Hotspot issue of clinical practice of multiple arterial grafting in coronary artery bypass surgery in China[J]. National Medical Journal of China, 2019, 99(14): 1048-1052.
[24] Kitamura S, Seki T, Kawachi K, et al. Excellent patency and growth potential of internal mammary artery grafts in pediatric coronary artery bypass surgery. New evidence for a “live” conduit[J]. Circulation, 1988, 78(3 Pt 2): I129-I139.
[25] CHEN Xujun, ZHANG Yong,CHEN Xin, et al. Role of radial artery in total arterial myocardial revascularization in coronary bypass surgery [J]. Chinese Medical Journal, 2008,121(3): 200-204.
[26] Hata M, Shiono M, Sezai A, et al. Determining the best procedure for radial artery harvest: prospective randomized trial for early postharvest complications[J]. J Thorac Cardiovasc Surg, 2005, 129(4): 885-889.
[27] Gaudino M, Crea F, Cammertoni F, et al. Morpho-functional features of the radial artery: implications for use as a coronary bypass conduit[J]. Ann Thorac Surg, 2014, 98(5): 1875-1879.
[28] Dogan A, Sever K, Mansuroglu D, et al. Mönckebergs arteriosclerosis: a possible reason for non-use of radial conduit[J]. Asian Cardiovasc Thorac Ann, 2019, 27(8): 685-687.
[29] Liu Y, Qin KJ, Zhu JX, et al. Radial artery graft in coronary artery bypass surgery 1 week to 1 year postoperation[J]. J Thorac Dis, 2023, 15(12): 6408-6418.
[30] Buxton BF, Hayward PA, Raman J, et al. Long-term results of the RAPCO trials[J]. Circulation, 2020, 142(14): 1330-1338.
[31] Gaudino M, Prati F, Caradonna E, et al. Implantation in coronary circulation induces morphofunctional transformation of radial grafts from muscular to elastomuscular[J]. Circulation, 2005, 112(9 Suppl): I208-I211.
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