Follow-up in a patient with previous coronary artery bypass grafting with clipping for moderate stenosis of the native artery due to Kawasaki disease

We report the beneficial outcome of coronary artery bypass grafting (CABG) with aneurysm clipping for Kawasaki disease (KD)-related moderate stenosis of the native coronary artery. A 13-year-old boy developed 90% stenosis of the left anterior descending artery (LAD) and an aneurysm with 50% stenosis of the right coronary artery (RCA) seven years after KD. We grafted the RCA with the right internal thoracic artery (RITA) and clipped the proximal RCA, in addition to conventional grafting of the LAD with the left internal thoracic artery, because we were concerned that competition in flow between the native RCA and the graft might lead to graft occlusion. Significant ischemic change developing during the operation was not detected. Postoperative coronary angiograms showed complete occlusion of the proximal RCA and LAD and good bilateral ITA graft flow. A postoperative electrocardiogram revealed an abnormal Q wave in lead III. No perfusion defects were detected in 99mTc myocardial perfusion imaging. He stopped warfarin immediately after his operation, and aspirin one year later. He has been in good condition for 4 years after CABG. This report demonstrates, one of the graft procedures for moderate coronary stenosis, although the indication is limited.