Successful repair of a coronary artery to pulmonary artery fistula with saccular artery aneurysm and critical stenosis of the left anterior descending coronary artery.

We report an infrequent case of an adult patient with a coronary artery to pulmonary artery fistula associated with a coronary artery aneurysm, a critical stenosis of the left anterior descending coronary artery (LAD) and a LAD dissection located distally to the stenosis. The fistula was successfully closed with direct sutures by opening the aneurysm under complete cardiopulmonary bypass. The excess aneurysm wall was excised and aneurysmorrhaphy was performed. Closure of the distal opening of the fistula was carried out without pulmonary arteriotomy and the operation was completed with a coronary artery bypass graft on the LAD with the left internal mammary artery used as "free graft". Postoperative angiographic evaluation demonstrated a normal artery distribution and the patient was asymptomatic without recurrence at 6 months after the operation.