Case 1 presented congestive heart failure with atrial fibrillation. Echocardiography and cardiac catheterization demonstrated mitral regurgitation and communications between the right and left coronary arteries and pulmonary artery (PA). The fistula orifice was directly closed and mitral annuloplasty was done at the same time. Case 2 had a history of open mitral commissurotomy for mitral atenosis (MS), and was diagnosed as to be re-MS. Selective coronary angiography (CAG) newly documented an aberrant artery originating from the left coronary artery and draining into the distal right PA. At operation, the origin of the aberrant artery was successfully ligated, and mitral valve was replaced with a prosthetic one. This paper presented relatively rare types of coronary artery fistulae, focusing on the importance of routine CAG before open heart surgery and of consideration on the association of this anomaly in respect to perioperative myocardial protection.

Between February 1999 and November 1999, 33 patients (age 67.0±7.6 years old) underwent off-pump CABG using coronary shunt tubes. The number of graft anastomoses per patient was 2.8±0.8. The operative mortality was 0%. There was no incidence of on-pump conversion, low cardiac output syndrome, IABP insertion, mediastinitis or stroke. The maximum CPK-MB during the perioperative period was 25.9±18.8IU/l. One patient had perioperative myocardial infarction probably due to native coronary artery spasm. In patients with off-pump CABG, the intubation time, the ICU stay and the hospital stay were shorter. The number of patients who were extubated in the operating room was higher and the cost was lower than those with on-pump CABG. An early phase study revealed patency ratios of 85% (the previous term) and 97% (the latter term). Off-pump CABG is a safe and effective means of revascularization with no mortality, minimal morbidity and good short-term patency.