A 66-year-old man with an abnormal electrocardiogram during a health examination sought evaluation at the cardiology department. Contrast-enhanced computed tomography (CT) revealed the presence of aneurysms associated with aortopulmonary and left coronary artery-pulmonary artery fistulas. One of the identified aneurysms measured 20 mm. The patient was then referred to our department for surgical intervention. Although the patient was asymptomatic, surgery was planned due to the risk of rupture. Initially, coil embolization was performed to address the aortopulmonary fistula, which was followed by a median sternotomy. Intraoperatively, multiple tortuous abnormal vessels connecting both coronary arteries to the pulmonary artery were observed, along with aneurysms at the base of the pulmonary artery. The aneurysms were excised under cardiopulmonary bypass, and the opening of the pulmonary artery fistula was closed. Subsequent coronary angiography during surgery and postoperative cardiac CT confirmed the complete resolution of the abnormal vessels and aneurysms. The patient had an uneventful postoperative course and was discharged. We present the case of a patient with aneurysms associated with thoracic aortopulmonary and left coronary artery-pulmonary artery fistulas and review the relevant literature. The case was managed with a single-stage surgery involving coil embolization, aneurysm resection, and fistula closure.

A 48-year-old man was treated for heart failure at a nearby hospital, and echocardiography revealed thrombi in both ventricles. He was referred to our hospital for a detailed examination and treatment. Coronary angiography was performed, and the results were #2-3 50%, #5 50%, #6 100%, and #11 75%. Echocardiography revealed diffuse hypokinesis with an ejection fraction (EF) of 31%, which was indicative of old myocardial infarction. The left intraventricular thrombus was floating and adherent to the apex of the heart, and we judged that immediate surgical intervention was necessary to remove the thrombus and perform coronary artery bypass grafting. The right ventricular thrombus was removed through the tricuspid valve with an incision in the right atrium using a rigid endoscope to ensure that no thrombus remained behind. There were no perioperative embolic complications, and oral administration of direct oral anticoagulants (DOAC) was continued for one year after the operation. However, no recurrence of thrombosis was observed, and the prognosis was good.