Off-Pump Coronary Artery Bypass Grafting for Congenital Left Main Coronary Artery Stenosis in a Six-Month-Old Infant: A Novel Approach

We report a case of congenital left main coronary artery stenosis surgically treated at our center in a six-month-old patient using an off-pump coronary artery bypass grafting (CABG) approach. The infant presented with respiratory distress, feeding difficulties, and diaphoresis and was diagnosed with dilated cardiomyopathy with severe left ventricular dysfunction. Diagnostic imaging with computed tomography (CT) angiography and coronary angiography identified severe stenosis (>90%) of the left main coronary artery with normal right-sided coronary anatomy. A left internal thoracic artery to left anterior descending coronary artery anastomosis was performed using off-pump CABG, a novel intervention in an infant with congenital left main coronary artery stenosis. Postoperative recovery was smooth and three-year follow-up demonstrated normal development with significant improvement in left ventricular function (ejection fraction 55%). To our knowledge, this case represents the first successful application of off-pump CABG in an infant with congenital left main coronary artery stenosis, marking a pioneering step in pediatric cardiac surgery.