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目的 探讨川崎病后严重冠状动脉病变及搭桥手术 (CABG)后的近期及远期效果。方法 随访发现 ,6例川崎病后严重冠状动脉病变的病儿均有左冠状动脉前降支 (LAD)病变 ,右冠状动脉(RCA)病变 5例 ,左冠状动脉回旋支 (LCX)病变 3例 ,左冠状动脉主干 (LMT)病变 2例 ,心肌梗死 3例。共行 15支CABG :单支 2例 ,3支 3例 ,4支 1例 ;左胸廓内动脉 (LITA)至LAD 6例 ;右胸廓内动脉 (RITA)至LAD 1例 ,至LCX 1例 ;胃网膜右动脉 (RGEA)至RCA 2例 ;大隐静脉 (SVG)从主动脉至LAD 3例 ,至LCX 2例。结果 术后 1个月RGEA至RCA狭窄 1例 ,LITA至LAD阻塞 1例 ,其余血管均良好。随访1～ 4年 ,1例行 4支CABG的病儿术后 18个月发生心绞痛 ,经内科治疗后好转 ;造影显示SVG从主动脉至LCX及LITA至LAD严重狭窄。术后所有病儿左室收缩功能均有不同程度的改善。其他病儿均无心绞痛及心肌梗死发生 ,生长发育良好。结论 虽然少数川崎病后严重冠状动脉病变的病儿行CABG后可以发生狭窄或阻塞 ,但CABG能改善病儿的左室功能 ,并防止心肌梗死的再次发生
Objective To investigate the short-term and long-term effects of severe coronary artery disease and bypass surgery (CABG) after Kawasaki disease. Methods Six patients with severe coronary artery lesion after Kawasaki disease were followed up. Left anterior descending coronary artery (LAD), right coronary artery (RCA) lesion in 5, left LCA lesion in 3 , Left coronary artery (LMT) lesions in 2 cases, 3 cases of myocardial infarction. A total of 15 CABG patients were involved in this study. There were 2 cases with single branch, 3 cases with 3 cases and 1 case with 4 cases. There were 6 cases of left internal thoracic artery (LITA) to 6 cases of LAD, 1 case of right internal thoracic artery (RITA) 2 cases of RGEA to RCA, 3 cases of SVG from aorta to LAD, 2 cases to LCX. Results One month after RGEA to RCA stenosis, one case was occluded from LITA to LAD, and the rest of the vessels were well. After 1 to 4 years of follow-up, 1 patient with 4 CABG developed angina at 18 months after operation, which was improved after medical treatment. Angiography showed severe stenosis of SVG from aorta to LCX and LITA to LAD. All patients with postoperative left ventricular systolic function have different degrees of improvement. Other children were no angina pectoris and myocardial infarction, growth and development is good. Conclusions Although a small number of children with severe coronary artery disease after Kawasaki disease may have stenosis or obstruction after CABG, CABG can improve the left ventricular function and prevent the recurrence of myocardial infarction