RESUMO
A 64-year-old woman with an atrial septal defect (ASD) closure was referred to our hospital ; she presented with dyspnea at the time of admission. An echocardiogram showed mitral valve regurgitation, tricuspid valve regurgitation, and a residual ASD shunt. Coronary angiography revealed coronary-pulmonary artery fistulae originating from both the left anterior descending coronary artery and the right coronary artery (RCA). Closure of the coronary-pulmonary artery fistulae was performed in addition to mitral valve replacement, tricuspid valve plasty and ASD closure. The postoperative course was uneventful. Coronary angiography was performed, and some of the contrast medium remained in parts of the RCA fistulae. Ligation of the fistulae and direct closure of the intra-pulmonary openings during cardiopulmonary bypass had to be performed because of complete obstruction of the coronary-pulmonary artery fistulae.