We describe a patient with pulmonary hypertension associated with an atrial septal defect (ASD) who suffered an acute myocardial infarction. The patient, 70-year-old man, was admitted to our hospital after developing chest pain. He had een diagnosed as having an ASD at the age of 69. From the electrocardiogram obtainedon admission, acute myocardial infarction was suspected. Coronary anglography revealed total obstruction of the left anterior descending coronary artery, which was successfully treated by percutaneous transluminal coronary angioplasty(PTCA). Because of repeated heart failure, ASD closure and
coronary artery bypass grafting (CABG) were performed in a one-stage operation. After
surgery, cardiac function improved. Direct PTCA in the acute phase and ASD closure and CABG in the chronic phase were effective for heart failure in this patient
