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J Thorac Cardiovasc Surg 1996;111:181-189
© 1996 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

EXPANDING INDICATIONS FOR PEDIATRIC CORONARY ARTERY BYPASS

Chicago, Ill.

From the Divisions of Cardiovascular–Thoracic Surgery and Cardiology, The Children's Memorial Hospital, and the Departments of Surgery and Pediatrics, Northwestern University Medical School, Chicago, Ill.

Received for publication March 2, 1995. Accepted for publication May 9, 1995. Address for reprints: Constantine Mavroudis, MD, Division of Cardiovascular–Thoracic Surgery, Children's Memorial Hospital, 2300 Children's Plaza—M/C #22, Chicago, IL 60614.

Abstract

Pediatric coronary artery bypass has been done mostly for ischemic complications of Kawasaki disease. We reviewed our clinical experience between 1987 and 1994 with internal thoracic artery–coronary artery bypass in one infant and five children for varying indications. Indications for coronary bypass included Kawasaki disease (2), congenital left main coronary ostial stenosis, iatrogenic coronary cameral fistula, anomalous origin of the left coronary artery from the pulmonary artery, and single coronary artery traversing between the great arteries in a patient after cardiac transplantation. An additional cohort of 34 control patients of various ages and weights (1 day to 16.1 years, 2.6 kg to 62 kg) had angiographic measurements of the right coronary, left coronary, and left internal thoracic arteries with respect to the feasibility of performing coronary artery bypass. All six patients survived internal thoracic artery–left anterior descending coronary artery bypass without evidence of perioperative myocardial infarction. Postoperative angiographic studies in five and color Doppler echocardiography in one showed graft patency. Retrospective angiographic measurements in the 34 control patients showed that internal thoracic and coronary arteries are proportionately quite large in neonates and infants compared with those in older children and adolescents. Internal thoracic artery–coronary artery bypass should be considered for the expanding indications presented herein and when emergency intraoperative life–threatening situations present themselves. Long–term patency and reoperation rates have yet to be determined. (J THORACCARDIOVASCSURG1996;111:181-9)

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