Kawasaki disease is characterized by a variety of symptoms and signs resulted from systemic vasculitis. Although the etiology of the disease remains uncertain, its serious coronary sequelae have been proved to cause ischemic heart disease in children. Coronary artery aneurysms or ectasia develop in approximately 20% of untreated children with the disease and may lead to coronary ischemia. Although the incidence of severe coronary arterial stenosis is low (2-3%), but once myocardial infarction occurs in children, the mortality is quite high (22% at the first infarction). Children with coronary aneurysms should be assessed carefully with periodic stress testing for reversible ischemia. Coronary artery bypass surgery is indicated when there is an evidence of myocardial ischemia even in small children. However, one should keep in mind that the ability to recanalize or develop collateral vessels in children is very high and recanalization is frequently noted in the right coronary artery. Internal thoracic arteries are the graft of choice. We performed coronary bypass grafting in 5 patients with Kawasaki disease since 2001. The mean age of the patients was 18.8+/-11.2 (range, 2-30) year. The mean number of anastomosis was 1.8+/-1.1. All patients survived and have revealed no evidence of myocardial ischemia during follow-up.