ABSTRACT
We describe a case of ruptured coronary artery aneurysm with a coronary artery to a pulmonary artery fistula. An 89-year-old woman with general fatigue and dyspnea was admitted. At the visit she went into shock and was restored by rehydration therapy. Enhanced computed tomography shows a coronary aneurysm (maximum diameter of 50 mm) at the left side of pulmonary artery and mild pericardial effusions. She was scheduled for an emergency operation due to the ruptured coronary artery aneurysm with a coronary artery to pulmonary artery fistula. We performed aneurysmectomy and ligation of the coronary artery to the pulmonary artery fistula under cardiopulmonary bypass. We also reviewed 23 cases of ruptured coronary artery aneurysm with coronary artery extending to a pulmonary artery fistula in Japan. The disease is a rare clinical state and regarded as an indication for emergency surgery.