[Ruptured Saccular Small Coronary Artery Aneurysm Associated with a Coronary-pulmonary Artery Fistula:Report of a Case].

The patient was an 86-year-old woman. She was brought to the emergency department because of chest pain and respiratory distress symptoms that did not improve. 12-lead electrocardiogram, echocardiography, and blood tests were negative for acute coronary syndrome, but a chest contrast computed tomography( CT) -scan showed pericardial effusion and a coronary artery aneurysm 20 mm in diameter, and punctured pericardial effusion revealed bloody fluid. A cardiac catheterization was performed. He underwent emergent surgery after being diagnosed as having a ruptured coronary aneurysm associated with a coronary pulmonary artery fistula. The aneurysm was dissected using cardiopulmonary bypass, and the coronary artery-pulmonary artery fistula was closed. The patient had a good postoperative course and was discharged in good condition. There have been few reports of rupture when the aneurysm diameter is less than 30 mm. Regardless of the size of the aneurysm, it has a risk of rupture and it is important to consider surgery.