Abstract
We describe our experience with a patient who underwent surgery for a bilateral coronary-pulmonary artery fistula and a coronary artery aneurysm associated with preoperative cardiopulmonary arrest. A 47-year old woman lost consciousness and was transported by ambulance to the hospital. The patient regained consciousness in the ambulance, and presented at the emergency & critical care medical center of our hospital, but cardiopulmonary arrest occurred during examination. Echocardiography showed cardiac tamponade. Pericardial drainage was immediately performed, and spontaneous circulation was restored. After the induction of brain hypothermia, a careful examination revealed an aneurysm, 5 mm in maximum diameter, in the right coronary artery and an aneurysm, 8 mm in maximum diameter, in the left coronary artery. Bilateral coronary-pulmonary artery fistulas had thus developed. Cardiopulmonary arrest was apparently caused by the rupture of a coronary artery aneurysm. Aneurysmectomy was performed, and the coronary-pulmonary artery fistulas were closed during cardiopulmonary bypass. Photodynamic eye was useful for the intraoperative detection of small coronary artery aneurysms. On postoperative day 12, the patient was discharged from the hospital uneventfully.
