The patient was a 73-year-old female who developed a ventricular septal perforation (VSP) following an acute anterior myocardial infarction, requiring emergency surgery. We made an incision in the right ventricle (RV) wall, 2 centimeters away from, and parallel to, the left anterior descending coronary artery (LAD). We found an aproximately 15 mm perforation. The VSP was closed by the extended sandwich patch technique, taking care not to the injure LAD. Furthermore, coronary artery bypass graft (CABG) left internal thoracic artery (LITA) to LAD was performed. The postoperative course was good, and no residual shunt was detected on the echocardiogram on the fifth day after surgery. Postoperative coronary artery computed tomography (CT) showed all grafts, including the LITA-LAD, were patent, and the patient was discharged on the twelfth day after surgery. There is controversial about whether or not to perform revascularization of the culprit artery during VSP repair. Based on this case, it was thought that complete revascularization, including the culprit artery, should be considered in cases of VSP.

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.