[Intraoperative hypoperfusion after coronary artery bypass grafting in a child with Kawasaki's disease: report of a case].

An 11-year-old boy with Kawasaki's disease who developed congestive heart failure due to acute myocardial infarction underwent coronary artery bypass grafting using the bilateral internal thoracic arteries. The surgical procedures were performed to the left anterior descending artery with the right internal thoracic artery and to the diagonal branch with the left internal thoracic artery with the aid of extracorporeal circulation and cardiac arrest with blood cardioplegia. About 30 minutes after the discontinuation of extracorporeal circulation, catastrophic ventricular fibrillation with acute left heart failure occurred because of coronary hypoperfusion. The cardiopulmonary bypass was reestablished after 20 minutes of resuscitation under cardiac massage. Additional saphenous vein graft bypass to the left anterior descending coronary artery that was already revascularized by the right internal thoracic artery was performed. Weaning from the cardiopulmonary bypass was then possible, and the patient were successfully treated using the delayed sternal closure technique. Use of the bilateral internal thoracic arteries appears to be beneficial in children with Kawasaki's disease to produce grafts in the growing heart, but the possibility of early catastrophic flow deterioration must be recognized because smaller arerial size provides inadequate nutritional support for the myocardium. The additional use of saphenous vein grafting might be beneficial in the case of severe coronary ischemia with small-sized internal thoracic arteries.