Minimally invasive coronary artery bypass grafting surgery in a child with Kawasaki disease

An 8-year-old girl with Kawasaki disease underwent surgical revascularization to the left anterior descending coronary artery on the beating heart via a left anterior short thoracotomy. Angiography 21 months after surgery showed excellent graft patency. This case--the first success in minimally invasive surgical coronary artery revascularization in a child in the world--suggests that minimally invasive methods are a reasonable alternative in coronary artery revascularization in a child with Kawasaki disease whose left anterior descending artery is the only requiring it.     

MiR-155、miR-208和miR-499在川崎病患儿中的表达检测与分析

目的本文探讨心血管疾病相关的miR-155、miR-208和miR-499在川崎病患者中的表达水平及临床意义。方法纳入川崎病患儿52例,正常儿童20例作为对照;收集外周血,提取血浆中的RNA;采用实时荧光定量PCR检测这三种miRNA的表达并以RNU6B作为内参基因进行分析。结果与对照组比川崎病患儿中的miR-155表达水平明显升高(P=0.018),且miR-155表达水平与冠脉损害程度成一定程度的正相关。miR-208和miR-499在川崎病中的表达有一定程度升高,但均无显著性差异。结论 miR-155的高表达与儿童川崎病有关,提示其可以作为诊断川崎病的潜在标志物。     

Symptomatic coronary obstruction due to Kawasaki disease in an adult

Kawasaki disease is the most common cause of pediatric ischemic heart disease in the world, but it is unusual in adults. We present a case of Kawasaki disease in a young adult. This 20-year-old man presented with angina. Coronary angiography revealed aneurysmal obstructive lesions consistent with remote Kawasaki disease. The patient underwent coronary artery bypass grafting with arterial conduits. Postoperative echocardiography was normal and stress myocardial perfusion imaging showed no ischemia. He remained asymptomatic 12 months after surgery. There is controversy regarding optimal therapy, choice of conduit, treatment of proximal aneurysms, and surveillance in adults with Kawasaki disease.     

Popliteal aneurysm presenting as acute thrombosis and ischemia in a middle-aged man with a history of Kawasaki disease

Kawasaki disease is known to cause a vasculitis of small and medium-sized vessels, with subsequent aneurysm formation. Most of the severe manifestations of the disease occur as a result of coronary aneurysm formation. However, many other arteries have been documented to be involved. A case is presented of a middle-aged man with a history of Kawasaki disease who had an acute ischemic limb from a thrombosed popliteal aneurysm that formed as a result of the disease. This is the first known case report of Kawasaki disease resulting in delayed lower extremity ischemia. Typical findings of patients with Kawasaki disease are presented, along with a case report and review of the literature. A history of Kawasaki disease is an extremely rare but possible cause of peripheral aneurysms, even in middle-aged patients. (J Vasc Surg 1997;26:884-7.)     

Myocardial infarction in Kawasaki disease

A 5 1/2-month-old infant with Kawasaki disease complicated by coronary aneurysms is described. Despite myocardial infarction, the patient survived and is improving on medical management alone. Coronary aneurysms occur in 20% of cases presenting with Kawasaki disease. Medical management is aimed at preventing infarction and promoting healing of aneurysms. The use of anticoagulants and thrombolytics in Kawasaki disease is discussed.     

Case report of CABG for progressive coronary artery stenosis after 22-year history of Kawasaki disease

More than 30 years has passed since Kawasaki disease was recognized as an independent disease entity, but the cardiovascular complications of Kawasaki disease are still not well known. We report an 22-year-old woman who underwent triple coronary artery bypass grafting because of a coronary artery aneurysm and multiple coronary artery stenoses, 22 years after the diagnosis of Kawasaki disease. A 2 cm coronary artery aneurysm due to Kawasaki disease was diagnosed when she was 10 years old, when she first presented with the symptom of dyspnea on effort. Since then, she was followed at the outpatient clinic. When she was 19 years old, the first coronary catheterization was performed. Two years later, the second coronary catheterization revealed progression of coronary artery disease. Therefore, coronary artery bypass grafting was performed. This case is rare from the point of view of long-term progression of coronary artery disease.     

Ischemic small bowel strictures in a case of incomplete Kawasaki disease

The authors describe an atypical case of Kawasaki disease in a 9-month-old girl who presented with fever, coronary artery aneurysms, and acquired ischemic stricture of the proximal jejunum. Histology of the surgical specimen was consistent with mesenteric vasculitis. The infant had only some of the typical clinical signs of Kawasaki disease, suggesting that an atypical or incomplete form of the disease was present. To the best of the authors' knowledge this is only the third case to be reported of incomplete Kawasaki disease associated with ischemic bowel stricture. J Pediatr Surg 36:648-650.     

Coronary artery bypass grafting in an adult case with Kawasaki disease.

Surgical revascularization for coronary artery lesions secondary to Kawasaki disease has been rarely reported in adult patients. We reported an adult case with few coronary risk factors but with multiple coronary artery aneurysms and obstructive lesions presumably secondary to Kawasaki disease who underwent coronary artery bypass grafting (CABG) with multiple arterial grafts. The postoperative course was uneventful. Because coronary artery sequelae of Kawasaki disease can be a cause of ischemic heart disease even in adults, heightened awareness of this possibility is required for young adults with coronary lesions but without coronary risk factors.     

Subdural effusion in the acute stage of Kawasaki disease (Mucocutaneous lymph node syndrome)

A 6-month-old girl with complications of subdural effusions at the acute stage of Kawasaki disease is reported. Based on the pathology of Kawasaki disease and considering the possibility of systemic vasculitis, the subdural effusions were assumed to be attributable to vasculitis involving the dura mater.     

Coronary artery bypass grafting in adult coronary artery disease due to suspected Kawasaki disease in childhood

Development of coronary artery aneurysms is one typical complication of Kawasaki disease and can cause coronary artery disease even in early childhood. Information about course and outcome in adults is rare. Here, we present a 49-year-old man with serious three-vessel coronary artery disease and giant coronary artery aneurysms following suspected Kawasaki disease.     

Coronary artery abnormalities in children with systemic-onset juvenile idiopathic arthritis

Still's disease (Systemic-onset Juvenile Idiopathic Arthritis: SoJIA) is characterised by high-spiking daily fevers, arthritis and evanescent rashes. Diagnosis of Still's disease is often challenging. Infectious diseases and other inflammatory conditions, especially in young children, Kawasaki disease may look similar. Clinicians often rely on echocardiographic evidence of coronary artery abnormalities to differentiate between Kawasaki disease and Still's disease. Coronary artery dilation would typically favour the diagnosis of Kawasaki disease. We present four children with Still's disease and coronary artery abnormalities who were initially misdiagnosed as Kawasaki disease. The first patient had pericarditis and an irregular wall of the left coronary artery, without dilation on echocardiography. The second patient had a left coronary artery dilatation and a pericarditis. The third patient had thickened left coronary artery walls, and the fourth patient had a hyperechogenicity of the left and right coronary arteries. They received IVIG without success. The diagnosis of Still's disease was made secondary with evidence of persistent arthritis. All but one patient finally needed biologic treatments. Coronary abnormalities may be observed during various febrile conditions and do not exclude the diagnosis of Still's disease.     

冠状动脉旁路移植术治疗6例儿童川崎病并发冠状动脉病变

目的 总结冠状动脉旁路移植治疗儿童川崎病并发冠状动脉病变的近、中期疗效.方法 2005年2月至2009年9月,6例川崎病并发冠状动脉病变病儿接受冠状动脉旁路移植,其中男5例,女1例;年龄6～12岁.确诊川崎病0.5～5.0年.冠状动脉左主干闭塞1例,左、右冠状动脉瘤样病变5例.心功能(NYHA)分级Ⅱ级1例,Ⅲ级5例.术前心脏超声示左室舒张末内径(LVDD)39～54 mm;左室收缩未内径(LVSD)23～45 mm;左室射血分数(LVEF)0.33～0.71;二尖瓣中度反流1例.均在体外循环下手术,移植血管均用动脉,平均旁路移植血管(2.0±0.6)根.其中左乳内动脉4根,桡动脉7根.同期冠状动脉成形术4例,二尖瓣成形术1例.结果 无手术死亡,体外循环平均(95.6±31.0)min;主动脉阻断平均(57.8±33.9)min.术后LVDD 32～56 mm,LVSD 21～39 mm,LVEF 0.45～0.71.冠状动脉CT示移植血管均通畅.均获随访,无远期死亡,病儿生长发育同正常同龄儿.随访0.1～4.5年,心功能平均(1.4±0.55)级.5例术后1年移植血管100%通畅,1例术后2年移植血管通畅.结论 冠状动脉旁路移植术可以有效治疗川崎病并发冠状动脉病变,全动脉化有利于旁路血管远期通畅,其近、中期疗效满意.     

Coronary bypass surgery in kawasaki disease in a four-year-old patient: case report

Kawasaki disease is an acute vasculitis syndrome of unknown etiology that mainly affects small and medium-sized arteries, particularly the coronary arteries. This disease is rarely seen in infants and young people in Turkey. In this short report, we present a four-year-old patient who has Kawasaki disease associated with coronary artery aneurysm and underwent coronary bypass grafting.     

Surgical treatment in an adult with coronary artery aneurysm at proximal site of left anterior descending artery; report of a case

A 52-year-old man was admitted to our hospital with complaint of chest pain and abnormal electrocardiogram (ECG) findings showing ST depression in V2-V6. Coronary computed tomography (CT) and coronary arteriography (CAG) showed coronary artery aneurysm at #5 [left main trunk (LMT)] 20 mm, #11 [circumflex artery (Cx)] 8.3 mm, RV branch 4 mm, and severe stenosis at #5 and #11. Therefore, his chest pain was due to thromboembolism from coronary artery aneurysm. In the present case, Kawasaki disease was not diagnosed in childhood. Coronary artery aneurysms were rare in the elderly and were usually found in association with Kawasaki disease. Morphological evaluation findings strongly suggested that the coronary artery aneurysm were related to Kawasaki disease. Resection of coronary artery aneurysm and coronary artery bypass grafting [left internal thoracic artery (LITA) to #8 and saphenous vein graft (SVG): aorta (Ao) to #14] were successfully performed. We report a case of coronary artery aneurysms presumed to be due to childhood Kawasaki disease in an elderly man.     

Kawasaki disease presenting as cervical lymphadenitis or deep neck infection.

OBJECTIVE: To describe a group of patients with Kawasaki disease who had cervical lymphadenopathy as their dominant initial presentations. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 14 children who were admitted to Chang-Gung Children's Hospital between May 1996 and July 1998 with the initial impression of cervical lymphadenitis, cellulitis, and/or deep neck infection but for which a diagnosis of Kawasaki disease was established later. RESULTS: Five (35.7%) patients were less than 5 months of age, and 8 (57.1%) patients were more than 53 months of age. The mean duration for establishing a diagnosis of Kawasaki disease from the onset of illness was 8.2 (6 to 20) days. Initially, empiric antibiotics were prescribed in each case with unsatisfactory response. Intravenous immune gamma globulin (2 g/kg) was administered in 13 patients. Three (21.4%) patients developed coronary artery lesions. CONCLUSION: If a child less than 6 months or more than 4 years of age has a fever and an enlarged cervical lymph node and is unresponsive to empiric antibiotics, Kawasaki disease should be considered.     

Anesthesia for aorto-coronary bypass graft surgery in children with Kawasaki disease

We investigated anesthetic management of aorto-coronary bypass graft surgery (CABG) in the children who have coronary disease due to acute febrile mucocutaneous lymph node syndrome (Kawasaki disease). A retrospective observation was made on anesthetic management of 17 patients with Kawasaki disease. They were 13 boys and 4 girls and their ages ranged from 5 to 13 years. They underwent CABG during the past 10 years (1976-1986) in Tokyo Women's Medical College Daini Hospital. Induction of anesthesia was carried out with halothane-nitrous oxide-oxygen (GOF) in 16 patients and morphine-nitrous oxide-oxygen (GOM) in one patient. Anesthesia was maintained with GOF in 11 patients, and in 6 patients with GOF and narcotics. High-dose fentanyl was not used for anesthetic induction in children with Kawasaki disease. Pulse rate increased significantly after endotracheal intubation. Blood pressure increased after endotracheal intubation in 5 patients and after sternotomy in one patient. Hypotension developed in 2 patients. Coronary spasm did not occur during the all procedures. Control of blood pressure during CABG in children was easier than in adult patients. But the control of pulse rate offers a problem in anesthetic management of the children with Kawasaki disease.     

Association of Kawasaki disease and interstitial nephritis

Renal insufficiency is a rare manifestation of Kawasaki disease. We report a 2·5-year-old boy with Kawasaki disease who developed acute renal failure during the acute phase of his illness. A percutaneous renal biopsy revealed acute interstitial nephritis. No etiological agent could be identified and renal recovery occurred with supportive care alone.     

Surgical experience with coronary arterial sequelae of Kawasaki disease in children

The coronary arterial sequelae due to Kawasaki disease have been treated surgically in five children ranged from 6 to 9 years old. The procedures were aortocoronary bypass surgery in all cases, coronary artery aneurysmectomy in one case and left ventricular aneurysmectomy in one case. The early results of operated cases have been good with the graft patency of 86% confirmed by angiography one month after surgery. The characteristic features of coronary artery damage in patients with Kawasaki disease are coronary artery aneurysms, which manifest wall irregularity, thrombus, calcification and stenosis. The significant stenosis of coronary artery could often be observed at the inlet or outlet of the aneurysm in major coronary artery branches. Although the early results of aortocoronary bypass surgery in the children with Kawasaki disease have been good, long-term follow up is mandatory to investigate the status of autogenous saphenous vein grafted in children.     

Coronary revascularization in a child with Kawasaki disease: use of right gastroepiploic artery

In coronary insufficiency produced by Kawasaki disease, myocardial revascularization using saphenous vein, internal mammary arteries, and a combination of both grafts has been performed with considerable success. Recently, we successfully used a right gastroepiploic artery as another conduit in coronary revascularization of a 6-year-old boy with Kawasaki disease. Use of the gastroepiploic artery was feasible even in a small child, and this technique is expected to contribute to long-term graft patency as an arterial graft adjunct to internal mammary arteries.     

Peripheral gangrene associated with Kawasaki disease and successful management using prostacycline analogue: a case report

We report a case of child-onset Kawasaki disease that presented as a prolonged fever and manifested with coronary aneurysms and peripheral gangrene of the lower limbs. Therapy with intravenous immunoglobulins, corticosteroids, aspirin, anticoagulants, and ilomedine, a prostacyclin analogue, resulted in rapid improvement in the patient's condition without extremity loss. Those treating patients with Kawasaki disease must be aware of possible vascular ischemia in the disease process that is reversible by early intervention treatments, including the use of a prostacycline analogue, that improve quality of life.