Coronary artery disease is a common problem in the adult population. However, it is rather a rare event in children. The most common cause of acquired coronary artery disease in children is Kawasaki disease. Some patients with coronary arterial stenoses after Kawasaki disease have been amenable for balloon dilatation therapy, however, the results have been mixed [1][2][3]. The availability of newer coronary interventional techniques may render more patients after Kawasaki disease to be amenable for catheter therapy [4,5]. Recently, we reported on a 16 1/2-yearold adolescent patient who benefitted from stent implantation for severe coronary artery stenosis after she sustained Kawasaki disease earlier in her childhood [6]. Another emerging etiology for acquired coronary arterial problems in children is the arterial switch operation where the coronary ostia are re-implanted in the neo-aortic root. One of the potential major complications of this operation is the possible occlusion of one of the coronary arteries [7,8].
In this issue of the journal, Aroney et al. [9] report on yet another new etiology (presumed embolic event) of acquired coronary obstruction in a child following mitral valve replacement for severe mitral regurgitation. The sudden deterioration in cardiac function and onset of new symptoms in this child dictated the need for cardiac catheterization and angiography to elucidate the etiology of the poorly dilated left ventricle. Failure of medical management led the authors to proceed with coronary intervention. Although, the result was not ideal, the left ventricular ejection fraction and patient's symptoms improved. For patients with chronic total occlusion of their coronaries, stent implantation after dilatation proved to be more effective in maintaining patency of the vessel than angioplasty alone [10]. However, in this patient due to the small vessel size, stent implantation was not possible. Also, in this issue of the journal, Moore and Buchbinder [11] report on a case of congenital coronary stenosis in a small child, an extremely rare