Clinical Presentation and Surgical Management of Pediatric Coronary Artery Disease: A Single-Center Retrospective Case Series

Background Pediatric coronary artery disease is rare and heterogeneous, with potentially severe clinical consequences. Data from resource-limited settings remains limited. This study aims to describe the clinical presentation and surgical management of pediatric coronary artery disease at a tertiary cardiac surgery center. Methods We performed a single-center retrospective case series of pediatric patients who underwent surgical intervention for coronary artery disease between 2018 and 2025. Demographic data, coronary pathology, surgical procedures, and early outcomes were analyzed. Results Eight patients (median age 10 years) were included. Fatigue was reported in four patients (50%) and chest pain in two (25%), and most patients had heart failure at presentation. Etiologies included Kawasaki disease-related coronary pathology in three patients (37.5%), anomalous coronary artery origin in three (37.5%, including one case of anomalous left coronary artery from the pulmonary artery (ALCAPA)), coronary artery fistula in two (25%), and tetralogy of Fallot-associated coronary anomalies in two (25%). Eleven surgical procedures were performed, with coronary artery bypass grafting being the most frequent approach (five procedures, 46%). Cardiopulmonary bypass was used in seven patients (87.5%). No early operative mortality was observed. Conclusions Pediatric coronary artery disease is heterogeneous and requires pathology-specific surgical strategies. Individualized surgical management was feasible with favorable early outcomes in a tertiary pediatric cardiac surgery center.