Left Main Ostial Stenosis in a Teenage Patient

Exertional chest pain in the setting of a structurally normal heart and no known arrhythmia are rarely thought to be related to cardiac etiology. Common non-cardiac etiologies of chest pain in the pediatric population include the following: lung infections, musculoskeletal, asthma, acid reflux, and anxiety. However, common cardiac etiologies that can cause exertional chest pain typically include the following: congenital heart disease, coronary anomalies, myocardial infections, left ventricular outflow obstruction, illicit drug use, and prothrombotic conditions. Rarely, pediatric patients present with an isolated finding of left main coronary artery ostial stenosis requiring intervention. Many of the published reports of left main ostial stenosis are in connection with other congenital heart disease, inflammation, or connective tissue disorders who have undergone percutaneous intervention. This report describes an 8-year-old patient with exertional chest pain for 5 years found to have isolated left ostial stenosis requiring coronary artery bypass grafting at the age of 13.