An 80-year-old woman with dextrocardia and situs inversus was admitted with chest pain. She successfully underwent off-pump coronary artery bypass grafting. The free left internal mammary artery (IMA) was anastomosed to the posterior lateral branch and the in-situ right IMA to the left anterior descending artery (LAD). The reconstruction of the LAD was performed with endarterectomy due to a diffusely diseased LAD with severe calcification. Except for the mirror-image anatomy, the surgical technique was similar to that used for patients with situs solitus.

A 53-year old female was noted to have an enlarged heart on a medical checkup. A multislice computed tomography study demonstrated a giant coronary artery aneurysm measuring 10 cm in diameter and a coronary arteriovenous fistula, both located below the left atrium. Resection of the aneurysm and ligation of the feeding arteries and arteriovenous fistula were performed under cardiopulmonary bypass. As the native coronary sinus was occluded, we reconstructed the vessels draining from the aneurysm into the right atrium with an autologous pericardial patch to preserve the coronary venous blood flow. To our knowledge this is the first report of an autologous pericardial patch being successfully used to reconstruct the coronary venous flow during surgical treatment of a giant coronary artery aneurysm with a coronary arteriovenous fistula.