The role of coronary bypass operation on children with Kawasaki disease.

BACKGROUND Kawasaki disease, initially called mucocutaneous lymph node syndrome was reported 35 years ago as a new inflammatory disease in infants and children and is characterized by a variety of symptoms and signs resulted from systemic vasculitis. Although the etiology of the disease remains unknown, its serious coronary complications have been proved to cause ischemic heart disease in children, and are now the most common cause of pediatric coronary disease in the world. The incidence of serious coronary sequelae is fortunately low (2-3% of patients with Kawasaki disease), but once myocardial infarction occurs in children, the mortality is quite high (22% at the first infarction). Development of surgical treatment for the disease was essential in preventing premature death and improving the quality of life of children. METHODS AND RESULTS Coronary revascularization surgery was attempted following careful evaluation of characteristic patters of coronary aneurysms and obstructions secondary to Kawasaki disease, although the surgical efficacy was initially questioned because the disease is inflammatory vasculitis in origin. The operation utilizing the pedicled internal thoracic artery has been demonstrated quite successful and now established as a reliable treatment for inflammatory coronary obstructions due to Kawasaki disease (the Kitamura Operation). There is valid evidence for the internal thoracic artery graft being a viable structure, accommodating in length and diameter for the growth of children. Results of the surgery and long-term prognosis are favorable and postoperative quality of life is markedly improved. CONCLUSIONS Coronary bypass operation utilizing the pedicled internal thoracic artery is a safe and reliable surgical modality for coronary artery sequelae in children due to Kawasaki disease. Long-term follow-up results up to 20-years are quite satisfactory.