Rare Congenital Coronary Anomaly of Myocardial Bridging in a Pediatric Patient With Isolated Single Coronary Artery

A 9-year-old boy was diagnosed with an isolated single coronary artery (ISCA) complicated by myocardial bridging, where an anomalous left main coronary artery (LMCA) arises from the proximal right coronary artery (RCA), with an intramyocardial course. The patient was referred for an echocardiogram after being diagnosed with hypertension, which revealed the ISCA, significantly increasing his risk of myocardial ischemia and sudden cardiac death. He experienced exercise-related chest pain, leading to a comprehensive cardiac evaluation. Cardiac computed tomography confirmed the anatomical abnormalities, and a treadmill stress test demonstrated intermittent ST segment depression during peak exercise. Surgical intervention included pulmonary artery mobilization, unroofing of the LMCA, and reattachment of the pulmonary artery. Postoperative echocardiograms showed unobstructed flow and normal biventricular function. Following surgery, the patient reported no further chest pain and exhibited significantly improved exercise tolerance. This case report highlights the critical importance of recognizing congenital coronary anomalies, in pediatric patients, and the necessity for thorough assessments during echocardiograms, as symptoms may often be misattributed to non-cardiac conditions. Early detection and intervention are essential to mitigate the risks associated with these rare cardiac anomalies.