Adult ; Coronary Aneurysm ; surgery ; Coronary Artery Bypass ; methods ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome ; surgery

Child ; Coronary Aneurysm ; diagnosis ; etiology ; surgery ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome ; complications

Humans ; Infant ; Mucocutaneous Lymph Node Syndrome/surgery* ; Coronary Artery Bypass/adverse effects* ; Coronary Aneurysm/surgery* ; Coronary Artery Disease/surgery*

BACKGROUNDKawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2% - 3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.

METHODSEight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5 +/- 0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.

RESULTSOne patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months), clincal angina disappeared or improved. Cardiac function was in Class I - II (NYHA).

CONCLUSIONCABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.

Adolescent ; Adult ; Child ; Child, Preschool ; Coronary Aneurysm ; pathology ; surgery ; Coronary Artery Bypass ; adverse effects ; methods ; Female ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome ; pathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the role of endogenous vascular elastase (EVE) in coronary artery between reconstruction among pediatric patients with Kawasaki disease (KD).

METHODSSixty children who were diagnosed with KD between January 2012 and April 2013 were selected as the case group, and peripheral venous blood samples were collected on days 0-11 (pathological stage I) and days 12-25 (pathological stage II) after the onset of disease; another 60 children without KD who visited the hospital due to acute fever during the same period were selected as the control group, and fasting peripheral venous blood samples were collected in the acute stage of fever. For both groups, serum levels of EVE and interleukin-6 (IL-6) and plasma vascular endothelial growth factor (VEGF) level were measured by enzyme-linked immunosorbent assay. For the case group, ultrasonic cardiography was used to detect coronary artery lesions (CALs) at the first, second and fourth weekends. The correlations of EVE level with IL-6 and VEGF levels were evaluated by Pearson correlation analysis.

RESULTSSerum levels of EVE and IL-6 in the case group in pathological stages I and II were significantly higher than in the control group (P<0.05), but plasma VEGF levels in stages I and II were significantly lower than in the control group (P<0.05); in the case group, EVE and IL-6 levels were significantly higher in stage II than in stage I (P<0.05). In pathological stage II, KD patients with CALs had significantly higher serum levels of EVE and IL-6 but significantly lower plasma VEGF levels compared with those without CALs (P<0.05); KD patients with coronary artery aneurysms (CAAs) had significantly higher serum levels of EVE and IL-6 but significantly lower plasma VEGF level compared with those without CAAs (P<0.05 for all). EVE level was positively correlated with IL-6 level (r=0.915, P<0.05), yet negatively correlated with VEGF level (r=-0.769, P<0.05).

CONCLUSIONSEVE may participate in coronary artery reconstruction in children with KD. To interfere EVE activity may reduce and prevent CALs.

Child ; Child, Preschool ; Coronary Artery Disease ; blood ; surgery ; Coronary Vessels ; surgery ; Female ; Humans ; Infant ; Interleukin-6 ; blood ; Male ; Mucocutaneous Lymph Node Syndrome ; pathology ; surgery ; Pancreatic Elastase ; blood ; physiology ; Reconstructive Surgical Procedures ; Vascular Endothelial Growth Factor A ; blood