Comprehensive surgical management of giant coronary artery aneurysm secondary to Kawasaki disease:5 cases report / 解放军医学杂志

ABSTRACT

Objective To investigate the clinical features and surgical management of giant coronary artery aneurysm due to mucocutaneous lymph node syndrome(Kawasaki disease).Methods From May 2006 to Oct.2007,5 patients with giant coronary artery aneurysm were undergone surgical correction.The aneurysm mainly appeared in the left bole of coronary artery and the right coronary artery.The ST segment of electrocardiogram changed in 5 cases,cardiac ejection fraction reduced observably in 4 cases,and 1 case suffered from cardiac dysfunction.Coronary angiography showed that the right coronary artery was entirely occluded and ventricular wall motion was depressed in one case.During operation,4 cases were undergone thrombus clearing,endoarterectomy and replasty of coronary artery(with additional procedure of stent placement in one case),one case was undergone coronary artery bypass grafting(CABG) with the aneurysm sequestration.Results The surgical results were satisfactory.No operative death occurred,and all the patients recovered uneventfully and were free of symptoms.In 4 cases,the ST segment of electrocardiogram showed that the blood supply of ischemic myocardium was improved,and the cardiac ejection fraction increased obviously.With 2 to 18 months following-up,all patients were free of symptoms with no death or coronary artery aneurysm recurrence.Conclusions For stage 3 Kawasaki disease complicated with giant coronary artery aneurysm,surgical procedure is necessary.The cardiac function can be improved greatly after comprehensive treatment of thrombus clearing,endoarterectomy,replasty of coronary artery and CABG.