Long-term results in surgical treatment of children 4 years old or younger with coronary involvement due to Kawasaki disease.

Problems in myocardial revascularization for coronary impairment due to Kawasaki disease were assessed in five patients 1 to 4 years old. Each patient had significant stenosis or complete obstruction with aneurysm formation. There were no operative or late deaths in the follow-up period of 1 to 10 years after operation. The coronary arteries, including the first diagonal branch and obtuse marginal branch, were 1 to 1.5 mm in diameter. Eight saphenous vein grafts used were 2.5 to 3.5 mm in diameter and the internal mammary arteries used in two patients, ages 2 and 4 years, were 1 mm in diameter. All nine grafts examined in the early postoperative period were patent. However, only three of eight saphenous vein grafts were patent in the late postoperative studies. One saphenous vein graft to the right coronary artery was found patent 7 years after surgery in a patient who had been operated on at the age of 3 years. Internal mammary artery grafts used in the last two patients in the series were both patent throughout the late postoperative period. This experience suggests that myocardial revascularization is surgically feasible and beneficial even in young children and that further study is warranted.