Surgical Treatment of Giant Coronary Artery Aneurysm Secondary to Kawasaki Disease

Authors

  • Chunhu Gu
  • Shanhong Fan
  • Heping Zhou
  • Yunya Wang
  • Dinghua Yi
  • Rong Zhao
  • Guocheng Sun

DOI:

https://doi.org/10.1532/HSF98.20091055

Abstract

Aim: To investigate the clinical features and surgical management of giant coronary artery aneurysm during end-stage Kawasaki disease.

Methods: From May 2006 to October 2007, 5 patients, 2 to 57 years old, presented with giant coronary artery aneurysm and underwent surgical correction. The coronary aneurysm diameters were 1.5 to 2.5 cm. The coronary aneurysm lesion sites included the right main coronary artery in 1 case, the left main coronary artery in 2 cases, and both the left and right coronary arteries in 2 cases. Preoperative electrocardiogram revealed altered S-T segments in 5 cases and reduced ejection fraction values in 3 cases, resulting in 1 emergency admission for congestive heart failure. Surgical treatments included thromboendarterectomy, thrombectomy, and aneurysmal reconstruction under the orthophoria of extracorporeal circulation.

Results: There were no operative deaths. All patients recovered and received dopamine 2 to 4 ?g/min per kg and nitroglycerine 0.3 to 0.5 ?g/min per kg. Time spent by patients in intensive care was uneventful. Following surgery, 4 patients showed ischemic improvement of the S-T segment on electrocardiograms, and 4 patients presented with increased ejection fraction, according to cardiac ultrasound inspection. The improvement of ejection fraction value was not significant in only 1 case.

Conclusion: Surgery is necessary for stage-3 Kawasaki disease patients that have giant coronary artery aneurysm complications. Surgical treatment includes thromboendarterectomy, thrombus clearing, aneurysmal reconstruction, and coronary artery bypass grafting, followed by postoperative anticoagulation and immunotherapy. Myocardial ischemia and cardiac function can be greatly improved through surgery.

References

Gong FQ, Shiraishi H, Momoi M. 2002. Follow-up of coronary artery lesions caused by Kawasaki disease and the value of coronary angiography. Chinese Med J (Engl) 115:6814.nHuang FJ, An CL, Yang JF, Sun D, Wu Q, Cheng W. 2004. Surgical treatment of coronary artery aneurysm. Chin J Thorac Cardiovasc Surg 20:113.nIliadis EA, Duvernoy CS. 2002. Stent placement for coronary stenosis in Kawasaki disease: case report and literature review. J Interv Cardiol 15:29-31.nKitamura S. 2002. The role of coronary bypass operation on children with Kawasaki disease. Coron Artery Dis 13:437-47.nLi DY, Hu SS, Sun LZ, et al. 2006. Surgical treatment of giant coronary artery aneurysm [in Chinese]. Zhonghua Wai Ke Za Zhi 44:1535-7.nReinerth G, Konradi D, Rupprecht HJ, Münzel T, Vahl CF. 2006. Revascularisation of a giant coronary aneurysm in suspected incomplete Kawasaki disease. Thorac Cardiothorac Surg 54:358-9.nYoshikawa Y, Yagihara T, Kameda Y, et a1. 2000. Result of surgical treatments in patients with coronary-arterial obstructive disease after Kawasaki disease. Eur J Cardiothorac Surg 17:515-9.n

Published

2009-08-14

How to Cite

Gu, C., Fan, S., Zhou, H., Wang, Y., Yi, D., Zhao, R., & Sun, G. (2009). Surgical Treatment of Giant Coronary Artery Aneurysm Secondary to Kawasaki Disease. The Heart Surgery Forum, 12(4), E241-E243. https://doi.org/10.1532/HSF98.20091055

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