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.

A 53-year-old man underwent aortic and mitral valve replacement, but postoperative cardioangiograms unexpectedly demonstrated aneurysms that had developed right-anteriorly and exactly anteriorly to the ascending aorta. They were initially thought to be pseudoaneurysms formed at the sites of aortotomy for valve replacement and of the aortic hole made by the needle puncture for air-venting. Operative findings, however, strongly suggested that it was a DeBakey type II dissecting aneurysm with two entries at the same sites as described. It was found that almost all distal parts of the aneurysmal cavity, probably a pseudolumen, had been occluded with clots, leaving two round cavities at the entries, which were preoperatively observed as pseudoaneurysms. The entries were successfully closed with approximation of the aortic walls using cardiopulmonary bypass, and the patient survived the operation.