Complete myocardial revascularization using only pedicled arterial conduits in Kawasaki disease

A 16-year-old boy with Kawasaki disease suffered from progressive angina an d exercise intolerance for 1 year. Coronary angiography showed 60% stenosis of the left main coronary artery, a calcified aneurysm with total occlusio n at die proximal left anterior descending artery (LAD), and another aneury sm with total occlusion at the middle portion of the right corollary artery . Aortocoronary bypass was done with the left interval mammary artery (IMA) anastomosed to the first obtuse marginal branch, the right IMA to the dist al LAD, and the right gastroepiploic artery to the posterior descending art ery. Graft patency was documented by follow-up coronary angiography 1 month after surgery. During follow-up, his rapid improvement led to an upgrade f rom New York Heart Association functional class III to class I. The results of the present case suggest that complete myocardial revascularization usi ng arterial conduits in patients with Kawasaki disease with coronary artery occlusion is safe and effective.