Rare bypass surgery saves 2-year-old with Kawasaki disease in Gurgaon
The child's severe coronary blockages and 25% heart function required a five-hour procedure that used both internal thoracic arteries, a method seldom applied to patients this young.
Also known as mucocutaneous lymph node syndrome, Kawasaki is an inflammatory condition that affects blood vessels in young children (under the age of 5) and can severely damage the heart. This can lead to serious heart complications, with around 5% of affected children developing large coronary artery aneurysms and severe vessel narrowing.
While the exact cause remains unknown, it is believed to stem from an abnormal immune response to an infection.
Diagnosed with Kawasaki disease at just eight months, the child initially received treatment locally. However, his condition progressively worsened. He would get breathless, fatigued easily, and was unable to play or keep up with other children. After multiple consultations, he was referred to Medanta for advanced care.
By the time he was admitted at the age of two, he was critically ill. Doctors at Medanta found his heart function dropped to just 25% (LVEF), and imaging revealed severely dilated and blocked coronary arteries.
A CT coronary angiogram confirmed aneurysms and complete blockages of both left and right coronary arteries, while a PET scan showed hibernating myocardium, areas of the heart muscle receiving inadequate blood flow but still viable.
Given the severity of the blockages and the child's failing heart, a team led by Dr Anil Bhan, chairman, cardiac surgery, cardiac care, Medanta, Gurgaon, opted for an exceptionally rare surgical approach, coronary artery bypass grafting using both internal thoracic arteries (ITAs), which is almost never performed on children this young. The internal thoracic arteries (ITAs) are preferred in such surgeries because they grow as the child grows and remain functional for life.
Highlighting the complexity of the surgery, Dr Bhan said, "Kawasaki disease is not very rare, but advanced coronary artery involvement requiring surgery is uncommon in children. The challenge in this case was not just the size of the child's arteries, but the fact that both the left and right coronary arteries were severely diseased. The surgery involved using both internal mammary arteries (IMAs) as grafts, which is technically complex.
We harvested the arteries and created new pathways to restore blood flow to the heart. This kind of double artery bypass is extremely rare in such young patients. The 5-hour procedure required meticulous precision, with surgeons using microsurgical techniques to ensure the grafts would hold and function effectively. Post-surgery imaging confirmed successful revascularisation—restoring healthy blood flow to the heart."
This was the second youngest Kawasaki-related coronary artery bypass surgery performed by Dr Anil Bhan, the first being in 2008 on a 1.5-year-old child, which was at the time recognised in world literature as the youngest CABG ever done.
Following the surgery, the child has shown encouraging signs of recovery. His heart function is steadily improving, and his energy levels have noticeably increased. The medical team expects his cardiac health to continue improving in the coming months.
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