Therapeutics
FANG LIU, n/a
Chief of Pediatric Cardiology, Deputy Director of Cardiac Center
Cardiac Center, Children’s Hospital of Fudan University, United States
Background: The management of giant coronary artery aneurysms (GCAA) after KD is challenge. The risk of thrombus detachment and myocardial infarction increases due to recurrent thrombosis or significant blood flow slowing within aneurysm. Successful coronary artery angioplasty is an ideal surgical treatment, but its effectiveness remains controversial, with limited reported cases. This article reported the mid-term follow-up outcomes of cases receiving coronary artery angioplasty in our center.
Method: This study included patients who underwent coronary artery angioplasty (endarterectomy, thrombectomy and downsizing reconstruction) at the heart center of children’s hospital of Fudan university, from June, 2018, to April, 2021.
Results: Five patients with GCAAs and severe CA stenosis/occlusion underwent coronary artery angioplasty (median (range) age at operation, 82 (58,137) months; median (range) weight, 24 (17,35) kg; median (range) interval between KD onset and surgery, 11 (3,36) months；4 boys [80%]). The median (range) follow-up period is 57.5 (26.8,61.5) months. All patients improved immediately after surgery. Dual antiplatelet drugs and warfarin were prescribed for one year, followed by dual antiplatelet drugs except for one case with saphenous vein graft who still had aspirin and warfarin. Seven CAs underwent surgery. Isolated angioplasty was performed in three left anterior descending arteries (LAD). In one case, LAD was patent with a medium-sized aneurysm one year after surgery. In another case, postoperative angiogram at one and five years revealed uneven contrast filling within aneurysm, but the distal segment was patent. In the remaining case, postoperative angiogram at one year showed significant stenosis at the distal part of aneurysm. It worsened to over 90% four years after surgery. Therefore, coronary artery bypass grafting (CABG) was performed. The left internal mammary artery (LIMA)-LAD graft showed good patency at one year. Angioplasty with CABG was performed in four CAs. In the case of LAD, postoperative angiogram at one and three years showed a persisting medium-sized aneurysm, along with a patent LIMA-LAD graft but with blood competition. In the three cases involving right coronary arteries (RCA), although the main trunks of RCA were barely visible in postoperative angiogram, the grafts were patent.
Conclusion: In the angioplasty of LADs, treatment effectiveness was satisfactory in two cases, while significant stenosis was observed in two cases. All three RCAs undergoing angioplasty were occluded. More cases and a longer follow-up period are required to assess the outcome of isolated coronary artery angioplasty. At present, it cannot be considered as one of the first-line treatment options.