冠状动脉旁路移植术治疗6例儿童川崎病并发冠状动脉病变

Coronary artery bypass grafting for coronary disease due to Kawasaki disease

目的 总结冠状动脉旁路移植治疗儿童川崎病并发冠状动脉病变的近、中期疗效.方法 2005年2月至2009年9月,6例川崎病并发冠状动脉病变病儿接受冠状动脉旁路移植,其中男5例,女1例 年龄6～12岁.确诊川崎病0.5～5.0年.冠状动脉左主干闭塞1例,左、右冠状动脉瘤样病变5例.心功能（NYHA）分级Ⅱ级1例,Ⅲ级5例.术前心脏超声示左室舒张末内径（LVDD）39～54 mm 左室收缩未内径（LVSD）23～45 mm 左室射血分数（LVEF）0.33～0.71 二尖瓣中度反流1例.均在体外循环下手术,移植血管均用动脉,平均旁路移植血管（2.0±0.6）根.其中左乳内动脉4根,桡动脉7根.同期冠状动脉成形术4例,二尖瓣成形术1例.结果 无手术死亡,体外循环平均（95.6±31.0）min 主动脉阻断平均（57.8±33.9）min.术后LVDD 32～56 mm,LVSD 21～39 mm,LVEF 0.45～0.71.冠状动脉CT示移植血管均通畅.均获随访,无远期死亡,病儿生长发育同正常同龄儿.随访0.1～4.5年,心功能平均（1.4±0.55）级.5例术后1年移植血管100%通畅,1例术后2年移植血管通畅.结论 冠状动脉旁路移植术可以有效治疗川崎病并发冠状动脉病变,全动脉化有利于旁路血管远期通畅,其近、中期疗效满意.

Objective To determine the efficacy of coronary artery bypass grafting （CABG） in children with coronary obstructive disease subsequent to Kawasaki disease. Methods Between Feb 2005 and Sep 2009, 6 children with ischemic heart disease due to Kawasaki disease comprised the study group. The age of patients at operation was ranged from 6 to 12 years with a mean of （ 8.0 ± 2.3 ） years. The preoperative EF was ranged from 0.33 to 0.71 with a mean of 0.57 ± 0.15. There was one case with moderate mitral valve regurgitation. Results All patients survived the procedures. The mean number of bypass graft was 2.0 ±0.6,with 4 internal thoracic arteries and 7 radial arteries. Mitral valve repair was employed in 1 case. The cardisc function （ NYHA and EF） was significantly improved postoperatively. Postoperative CTA showed no graft disease in all cases. Conclusion CABG using the arterial grafts can provide attractive mid-term results in patients with obstructive coronary arteries associated with Kawasaki disease.