There are no published non-Japanese series of children who have undergone coronary artery bypass grafting (CABG) procedures for sequelae of Kawasaki Disease (KD). Four children underwent CABG at our institution between 1988-1996, including the youngest known KD child anywhere to undergo CABG. These 4 children, among 600 KD patients seen from 1979-1996, presented with acute KD at 11 weeks, 3 mos., 4 mos., and 3 yrs. of age between 1983-1995; they underwent CABG at 6 yrs., 8 mos., 5-1/2 yrs., and 12 yrs. of age, respectively. Three additional KD patients had CABG performed elsewhere during this period. Initial treatment for acute KD included high dose aspirin only at illness days 14 and 21 (2), IVGG and high dose aspirin at illness day 11 (1), and no therapy (1). Initial echocardiograms at illness days 14, 21, and 75 showed 3 patients to have at least one large coronary aneurysm (CA); the fourth child showed no CA on the initial echos (illness days 11 and 15) but developed multiple large CAs by illness day 26. Pericardial effusions were present in 2/4 patients and mitral competence was noted in all 4 patients acutely. Indications for CABG in these 4 patients included wall motion abnormalities on dobutamine stress testing (1), on thallium stress testing(1), and ischemic ECG changes on treadmill testing (1), with angiographic confirmation of CA stenosis in all 3; in the fourth, ischemic ECG changes and ventricular tachycardia occurred during angiographic demonstration of severe RCA stenosis. CABG procedures included left IMA to LAD (2), right IMA to RCA(1), and both right and left IMAs to RCA and LAD (1). All 4 patients have done well clinically, tolerating normal activity 1-9 yrs. post-operatively. Post-operative evaluation included angiography within 10 days of surgery (3) and 13 mos. after CABG (1); all showed graft patency. The most recent echocardiographic evaluation showed normal shortening fractions (30-46%), although 2/4 have residual mild segmental wall motion abnormalities at rest. We conclude that CABG procedures benefit selected patients with CA abnormalities resulting from KD and are technically feasible in infants as young as 8 months.