A 64-year-old woman with an atrial septal defect (ASD) closure was referred to our hospital ; she presented with dyspnea at the time of admission. An echocardiogram showed mitral valve regurgitation, tricuspid valve regurgitation, and a residual ASD shunt. Coronary angiography revealed coronary-pulmonary artery fistulae originating from both the left anterior descending coronary artery and the right coronary artery (RCA). Closure of the coronary-pulmonary artery fistulae was performed in addition to mitral valve replacement, tricuspid valve plasty and ASD closure. The postoperative course was uneventful. Coronary angiography was performed, and some of the contrast medium remained in parts of the RCA fistulae. Ligation of the fistulae and direct closure of the intra-pulmonary openings during cardiopulmonary bypass had to be performed because of complete obstruction of the coronary-pulmonary artery fistulae.

We report the case of a 52-year-old man who presented with a 2-week history of exertional dyspnea and was admitted to our hospital with heart failure. Coronary angiography showed severe three-vessel disease ; left ventriculography revealed an aneurysm in the inferior left ventricular (LV) wall perforating into the right ventricle. We suspected the LV aneurysm was from a previous myocardial infarction (MI) that had perforated into the right ventricle, although the time of MI was unclear. The patient was treated with medications initially. We subsequently treated the patient by LV aneurysm closure using a patch and direct closure of the perforation by incising the aneurysm. Coronary artery bypass grafting was performed in the left anterior descending artery, the diagonal artery, and the right coronary artery simultaneously. After having an uneventful postoperative course, he was discharged from the hospital in a stable condition. A pathology examination confirmed a diagnosis of LV pseudo-false aneurysm.