EXPANDING INDICATIONS FOR PEDIATRIC CORONARY-ARTERY BYPASS

Pediatric coronary artery bypass has been done mostly for ischemic com plications of Kawasaki disease, We reviewed our clinical experience be tween 1987 and 1994 with internal thoracic artery-coronary artery bypa ss in one infant and five children for varying indications, Indication s for coronary bypass included Kawasaki disease (2), congenital left m ain coronary ostial stenosis, iatrogenic coronary cameral fistula, ano malous origin of the left coronary artery from the pulmonary artery, a nd single coronary artery traversing between the great arteries in a p atient after cardiac transplantation. An additional cohort of 34 contr ol patients of various ages and weights (1 day to 16.1 years, 2.6 kg t o 62 kg) had angiographic measurements of the right coronary, left cor onary, and left internal thoracic arteries with respect to the feasibi lity of performing coronary artery bypass, All six patients survived i nternal thoracic artery-left anterior descending coronary artery bypas s without evidence of perioperative myocardial infarction, Postoperati ve angiographic studies in five and color Doppler echocardiography in one showed graft patency, Retrospective angiographic measurements in t he 34 control patients showed that internal thoracic and coronary arte ries are proportionately quite large in neonates and infants compared with those in older children and adolescents, Internal thoracic artery -coronary artery bypass should be considered for the expanding indicat ions presented herein and when emergency intraoperative life-threateni ng situations present themselves, Long-term patency and reoperation ra tes have yet to be determined.