A School-Goer’s Nightmare: Case Report of CABG in an 8 Year-Old with Kawasaki Disease

Introduction: Kawasaki disease (KD) is an acute vasculitis primarily affecting medium-sized arteries, particularly the coronary arteries (CA). Its impact varies, with some patients developing transient dilation while others experience severe coronary artery aneurysms (CAA), leading to complications such as thrombosis, stenosis, and myocardial ischemia. Male gender, delayed diagnosis, incomplete presentation of KD, and resistance to Intravenous Immunoglobulin (IVIG) therapy are risk factors for CAA. The Japanese Ministry of Health classifies CAAs by size, with giant aneurysms (>8 mm) carrying significant long-term risks, including coronary thrombosis and acute coronary syndrome. Case Report: We report the case of an 8-year-old Malay boy with giant CAA secondary to KD. The patient presented with classical KD symptoms and inflammatory markers, with echocardiography revealing a giant aneurysm (8.7 mm) in the left anterior descending artery (LAD), alongside smaller aneurysms in the left circumflex and right coronary arteries (RCA). Initial management included IVIG, aspirin, and heparin, with warfarin and clopidogrel added subsequently. Coronary angiography indicated severe LAD stenosis (95%) with total occlusion and an aneurysmal segment distal to the occlusion. A multidisciplinary team determined that coronary artery bypass grafting (CABG) using bilateral internal mammary arteries was the optimal intervention. The patient had a favourable recovery and was stable at discharge. Discussion: CABG is recognized as a preferred treatment for severe or multivessel coronary involvement in KD, offering lower reintervention rates compared to percutaneous coronary intervention (PCI). Studies support CABG’s efficacy in managing coronary complications in KD, especially for complex or multivessel cases. Conclusion: This case illustrates the complexities of managing giant CAAs in paediatric KD and underscores the necessity of a multidisciplinary approach and long-term monitoring to