Surgery for coronary heart disease due to mucocutaneous lymph node syndrome (Kawasaki disease). Report of 6 patients.

Early and late surgical results in 6 patients with coronary heart disease secondary to mucocutaneous lymph node syndrome (MLNS) (Kawasaki disease) are presented. There were 5 male patients and 1 female patient, ranging in age from 2.5 to 26 years at the time of operation. They had severe coronary artery narrowings, obstructions, and aneurysms with or without mitral regurgitation. Previous myocardial infarction was documented in 5 patients. Aortocoronary bypass grafting utilizing the autologous saphenous vein was performed in 5 patients; in the remaining patient, mitral valve replacement was carried out. No operative or late deaths have been encountered. A long-term bypass graft patency was demonstrated in patients aged 26, 17, and 10 years with resulting clinical, angiographic, or scintigraphic improvements, or a combination of these. However, the graft that had been patent in a 4-year-old boy was found completely obstructed 3 years after surgery without any symptomatic changes. The formation of rich collateral channels was found. The risk of saphenous vein graft closure may be high in young growing children. In older children or adolescents, however, coronary vein bypass grafting for this specific inflammatory coronary artery lesion has been effective with long-term graft patency. Severe mitral regurgitation is also an indication for surgery, but poor left ventricular function associated with mitral regurgitation, probably secondary to myocarditis, persists after surgery and may give rise to future problems.