{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T06:31:14Z","timestamp":1764570674569,"version":"3.46.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Familial hypercholesterolemia (FH), particularly homozygous or compound heterozygous forms, predisposes individuals to premature cardiovascular disease due to severely elevated low-density lipoprotein cholesterol (LDL-C). This case report describes a 14-year-old boy with compound heterozygous pathogenic variants in the LDLR gene, diagnosed with FH with a strong family history of hypercholesterolemia. Despite early initiation of statins, the patient developed progressive angina pectoris. Coronary angiography revealed critical stenosis in the left main arteries, necessitating urgent coronary artery bypass grafting (CABG). Arterial as opposed to venous conduit selection in pediatric homozygous familial hypercholesterolemia warrants explicit rationale. In the postoperative stage, LDL-C levels remained elevated but were managed with adjunctive therapies, including PCSK9 inhibitor. Genetic testing confirmed compound heterozygosity, underscoring the aggressive nature of LDLR dysfunction. This case highlights the challenges of managing severe FH in pediatric patients, emphasizing the importance of early genetic diagnosis, multimodal lipid-lowering therapy, and timely surgical intervention to prevent life-threatening complications. It also reinforces the necessity of lifelong monitoring and developing novel therapeutic strategies to treat compound heterozygous FH cases. This report contributes to the limited literature on CABG in pediatric FH, advocating for a multidisciplinary approach to optimize outcomes in this high-risk population.<\/jats:p>","DOI":"10.3389\/fped.2025.1625247","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T06:24:18Z","timestamp":1764570258000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Coronary artery bypass grafting in a 14-year-old boy with compound heterozygous LDLR familial hypercholesterolemia: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Ke","family":"Zhu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fuqiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunjing","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1007\/s11883-014-0482-5","article-title":"Familial hypercholesterolemia\u2014epidemiology, diagnosis, and screening","volume":"17","author":"Singh","year":"2015","journal-title":"Curr Atheroscler Rep"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.atherosclerosis.2017.12.006","article-title":"Autosomal recessive hypercholesterolemia in Spain","volume":"269","author":"S\u00e1nchez-Hern\u00e1ndez","year":"2018","journal-title":"Atherosclerosis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.atherosclerosis.2019.06.905","article-title":"Toward a new clinical classification of patients with familial hypercholesterolemia: one perspective from Spain","volume":"287","author":"Masana","year":"2019","journal-title":"Atherosclerosis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1742","DOI":"10.1161\/CIRCULATIONAHA.119.044795","article-title":"Prevalence of familial hypercholesterolemia among the general population and patients with atherosclerotic cardiovascular disease","volume":"141","author":"Hu","year":"2020","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2553","DOI":"10.1016\/j.jacc.2020.03.057","article-title":"Worldwide prevalence of familial hypercholesterolemia","volume":"75","author":"Beheshti","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"17093","DOI":"10.1038\/nrdp.2017.93","article-title":"Familial hypercholesterolaemia","volume":"3","author":"Defesche","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"B7","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1093\/eurheartj\/ehu058","article-title":"Homozygous autosomal dominant hypercholesterolaemia in the Netherlands: prevalence, genotype\u2013phenotype relationship, and clinical outcome","volume":"36","author":"Sjouke","year":"2015","journal-title":"Eur Heart J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2277","DOI":"10.1093\/eurheartj\/ehad197","article-title":"2023 update on European Atherosclerosis Society Consensus Statement on Homozygous Familial Hypercholesterolaemia: new treatments and clinical guidance","volume":"44","author":"Cuchel","year":"2023","journal-title":"Eur Heart J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"572176","DOI":"10.3389\/fgene.2020.572176","article-title":"Genetic and clinical characteristics of patients with homozygous and compound heterozygous familial hypercholesterolemia from three different populations: case series","volume":"11","author":"Marusic","year":"2020","journal-title":"Front Genet"},{"key":"B10","doi-asserted-by":"publisher","first-page":"3478","DOI":"10.1093\/eurheartj\/eht273","article-title":"Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society","volume":"34","author":"Nordestgaard","year":"2013","journal-title":"Eur Heart J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/j.annfar.2011.01.014","article-title":"Recommandations de bonnes pratiques cliniques sur la nutrition p\u00e9riop\u00e9ratoire. 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