Recurrent Left Main Occlusion in Pediatric Kawasaki Disease: Surgical Patch Angioplasty With Autologous Pulmonary Trunk.

BACKGROUND: Coronary ostial stenosis is a particularly rare but life-threatening complication in children with Kawasaki disease, posing significant anatomical and technical challenges for surgical management. CASE SUMMARY: We report the case of a child with Kawasaki disease who developed recurrent left main coronary artery occlusion, presenting initially with cardiac arrest, and required emergency extracorporeal membrane oxygenation support. He underwent multiple revascularization procedures, including percutaneous coronary intervention and coronary artery bypass grafting (CABG), both of which ultimately failed. Persistent myocardial ischemia necessitated surgical patch angioplasty (SPA) of the left main stem using an autologous pulmonary trunk patch. DISCUSSION: Although surgical revascularization including CABG is commonly performed in cases of severe left main coronary artery occlusion, the potential role of SPA in pediatric patients remains underexplored. TAKE-HOME MESSAGE: SPA using autologous pulmonary artery offers a potentially advantageous alternative for coronary reconstruction in small children, particularly in cases of isolated proximal coronary stenosis or where traditional CABG may be technically challenging or unsustainable owing to small conduit caliber.