Triple Arterial Coronary Artery Bypass Grafting Including the Gastroepiploic Artery in Kawasaki Disease-Related Coronary Aneurysms

Abstract Introduction Kawasaki disease is an acute systemic vasculitis of childhood and represents the leading cause of acquired heart disease in developed countries. Coronary artery aneurysms and thrombosis are serious long-term complications that may necessitate surgical revascularization. In paediatric and adolescent patients, conduit selection for coronary artery bypass grafting remains challenging, with arterial grafts favoured because of their long-term patency and growth potential. The use of the gastroepiploic artery in this population remains uncommon and sparsely reported. Case Description We report the case of a 15-year-old female with a five-year history of Kawasaki disease who presented with progressive exertional dyspnoea. Coronary angiography revealed a large left main coronary artery aneurysm, a thrombosed aneurysm causing total occlusion of the left anterior descending artery, and thrombosis of the mid right coronary artery. Percutaneous intervention was considered anatomically unsuitable, and surgical revascularization was selected. The patient underwent total arterial coronary artery bypass grafting using the left internal thoracic artery to the left anterior descending artery, the right internal thoracic artery to the obtuse marginal branch, and the gastroepiploic artery to the right coronary artery. The postoperative course was uneventful, and at three-month follow-up, the patient demonstrated complete resolution of dyspnoea and good functional status. No postoperative computed tomography angiography or invasive coronary angiography was performed; therefore, objective graft patency was not confirmed. Discussion This case demonstrates the technical feasibility of a triple-arterial coronary revascularization strategy incorporating the gastroepiploic artery in an adolescent with Kawasaki disease-related complex multivessel coronary involvement. Although the patient showed favorable clinical recovery at three months, the absence of postoperative graft imaging and longer-term follow-up precludes conclusions regarding graft patency, effectiveness, or long-term durability. The gastroepiploic artery may represent an additional arterial conduit in carefully selected patients when anatomical and target-vessel characteristics are favorable.