Advances in Kawasaki disease bypass surgery for coronary artery obstructions

Coronary bypass surgery for the sequelae of Kawasaki disease is effective in improving cardiac function during exercise and probably in preventing sudden deaths and myocardial infarction in children, although surgical efficacy was initially questioned because the disease is inflammatory vasculitis in origin. The operation utilizing the pedicled arterial grafts is now established as a reliable treatment for severe inflammatory coronary obstructive disease due to Kawasaki disease (Kitamura Operation). Results of the surgery and long-term follow up are quite satisfactory up to 20 years. The postoperative quality of life is also markedly improved allowing over 85% of children with surgery to take full exercise at school, although all of them were prohibited from exercise before operation.The pedicted internal thoracic artery graft is not only excellent in its long-term patency but also is capable of growing with the child and meeting the perfusion demand of the myocardium. Thus, it is an ideal graft material for coronary artery reconstruction in children. Use of bilateral internal thoracic arteries is also safe in growing children. Moreover, right gastroepiploic artery grafts are useful in children with distal coronary artery lesions. The use of vein grafts should be avoided in children, because the patency rate is significantly poorer than arterial grafts. The benefits of surgical treatment for severe coronary artery lesions due to Kawasaki disease have now been recognized not only in Japan but all over the world.