Autologous patch angioplasty using a pericardial patch is a feasible surgical approach for treating giant RCA aneurysms and ostial stenosis in young children with Kawasaki disease, avoiding the need for mammary grafting.
May offer graft-sparing repair in rare pediatric Kawasaki cases; hypothesis-generating and requires larger series before wider consideration.
We describe our management of a 2-year-old patient with Kawasaki disease with a giant proximal right coronary artery (RCA) aneurysm and a >99% RCA ostial stenosis. After median sternotomy and cardioplegic arrest of the heart, we opened the aorta and cut into the RCA ostium past the stenosis and giant aneurysm. The RCA was reconstructed with an autologous pericardial patch. Cross-clamp and cardiopulmonary bypass times of 84 minutes and 114 minutes, respectively, were required. Our approach avoids mammary harvesting and grafting in such small patients while successfully treating ischemia and hopefully prevents further aneurysmal dilation over time.
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Ganta et al. (2019) studied this question.
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