Abstract
We report the postoperative course of native and graft flow after coronary artery bypass grafting (CABG) in two patients with giant aneurysms and localized stenosis due to Kawasaki disease (KD). Although both patients had undergone CABG to the left anterior descending artery (LAD) with the left internal thoracic artery (ITA), at 5 and 10 years old, respectively, the ITA grafts were occluded 1 month postsurgery. However, when the two patients suffered complete occlusion of the native LAD more than 10 years after surgery, angiograms showed that the ITA grafts had reopened. We believe that this postoperative course reflects competition between the native artery flow and graft flow after CABG. CABG in patients with severely delayed coronary flows or recurrence of thrombus in giant aneurysms was ineffective in preventing myocardial infarction or damage. We conclude that CABG in giant aneurysm without significant localized stenosis should be avoided.
Similar content being viewed by others
References
Akagi T, Ogawa S, Ino T, et al. (2000) Catheter interventional treatment in Kawasaki disease: a report from the Japanese Pediatric Interventional Cardiology Investigation Group. J Pediatr 137:181–186
Kato H, Ichinose E, Kawasaki T (1986) Myocardial infarction in Kawasaki disease: clinical analyses in 195 cases. J Pediatr 108:923–927
Kitamura S, Seki T, Kawachi K, et al. (1989) Excellent patency and growth potential of internal mammary artery grafts in pediatric coronary bypass surgery: new evidence for a “live” conduit. Circulation 78(Suppl):I129–I139
Kitamura S (2002) The role of coronary bypass operation on children with Kawasaki disease. Coron Artery Dis 13:437–447
Miyazaki A, Tsuda E, Miyazaki S, et al. (2003) Percutaneous transluminal coronary angioplasty for anastomotic stenosis after coronary artery bypass grafting in Kawasaki disease. Cardiol Young 13(3):284–289
Nakano H, Ueda K, Saito A, et al. (1985) Repeated quantitative angiograms in coronary arterial aneurysm in Kawasaki disease. Am J Cardiol 56:846–851
Suzuki A, Kamiya T, Tsuda E, et al. (1997) Natural history of coronary artery lesions in Kawasaki disease. Prog Pediatr Cardiol 6:211–216
Tsuda E, Kitamura S (2004) The cooperative study of Japan. National survey of coronary artery bypass grafting for coronary stenosis due to Kawasaki disease in Japan. Circulation 110(Suppl II):II61–II66
Tsuda E, Ono Y, Tsukano S, et al. (1998) Long-term results of coronary artery bypass grafting for coronary arterial lesions due to Kawasaki disease: cases with new appearance of localized stenosis after surgery. In: Imai Y, Momma K (eds) Proceedings of the Second World Congress of Pediatric Cardiology and Cardiac Surgery. Futura, New York pp 1117–1119
Tsuda E, Kamiya T, Ono Y, et al. (2005) Incidence of stenotic lesions predicted by acute phase changes in coronary arterial diameter during Kawasaki disease: threshold for coronary aneurysm causing stenosis is 6.0mm. Pediatr Cardiol 26:73–79
Yoshikawa Y, Yagihara T, Kameda Y, et al. (2000) Results of surgical treatments in patients with coronary-arterial obstructive disease after Kawasaki disease. Eur J Cardio-thorac Surg 17:515–519
Acknowledgments
We thank Professor Peter Olley and Dr. Setsuko Olley for their kind English language consultation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tsuda, E., Fujita, H., Yagihara, T. et al. Competition Between Native Flow and Graft Flow After Coronary Artery Bypass Grafting. Impact on Indications for Coronary Artery Bypass Grafting for Localized Stenosis with Giant Aneurysms Due to Kawasaki Disease. Pediatr Cardiol 29, 266–270 (2008). https://doi.org/10.1007/s00246-007-9114-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-007-9114-y