A Pediatric Case of Cardiogenic Shock Bridged With ECMO Due to a Malignant Left Main Coronary Artery Anomaly

Background Malignant left main coronary artery (LMCA) anomalies are rare but potentially fatal congenital defects that may cause myocardial ischemia or sudden cardiac death during exertion, even in otherwise healthy children. Early recognition and timely intervention are crucial to prevent catastrophic outcomes. Case Presentation: We report a 10-year-old boy who presented with acute chest pain and dyspnea during exercise, followed by pulmonary edema and refractory cardiogenic shock. Electrocardiography showed persistent ST-segment elevation, and coronary CT angiography revealed a malignant LMCA with an interarterial and intramural course between the aorta and pulmonary artery. Despite intensive medical therapy, the patient required emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. After stabilization, surgical re-anastomosis of the LMCA to its anatomical position was successfully performed. Outcome: The patient recovered rapidly, with normalization of cardiac enzymes and resolution of electrocardiographic abnormalities. At follow-up, he remained clinically stable after elective coronary stenting. Conclusion This case highlights the importance of maintaining a high index of suspicion for malignant LMCA anomalies in children presenting with exertional chest pain. Prompt hemodynamic support with ECMO and timely surgical correction can be lifesaving in these rare but high-risk conditions.