A rare case of bilateral coronary–pulmonary artery fistulas combined with an aortopulmonary fistula and hemangiomas

Coronary artery–pulmonary artery fistula (CPAF) is a rare coronary artery anomaly, defined as an abnormal communication between a coronary artery and the pulmonary artery. CPAFs account for approximately 15–30% of all coronary artery fistulas, with an estimated prevalence of 0.17–0.68% in the general population. We report an extremely rare case of bilateral coronary–pulmonary artery fistulas complicated by an aortopulmonary fistula and large hemangiomas, presenting predominantly with symptoms of heart failure. The patient underwent surgical resection of the hemangiomas and direct closure of multiple fistulous communications under cardiopulmonary bypass, with an uneventful postoperative recovery. Comprehensive preoperative imaging and multidisciplinary evaluation enabled successful surgical management and a favorable outcome. This case provides valuable clinical insights for the diagnosis and treatment of similarly complex coronary fistulas.