Coronary artery aneurysm with fistula is a relatively rare disease. After surgery, residual coronary fistula is often a problem. To prevent these problems, we perform coronary angiography during surgery, and have good grades. A 70-year-old-woman was admitted to our hospital with a chief complaint of palpitations. Enhanced computed tomography (CT) showed coronary aneurysms. Coronary angiography confirmed the coronary artery aneurysms with fistula to the pulmonary artery. Surgical intervention in the hybrid operating room was performed through median sternotomy with cardiopulmonary bypass. The fistulae were ligated, and the aneurysms were resected. Finally, coronary angiography was performed to confirm that there were no residual shunt aneurysm, or damage to the normal coronary artery, and the operation was completed. Postoperative course was uneventful, and she was discharged on postoperative day 19. Performing coronary angiography during surgery is very useful to confirm the aneurysms are completely closed, coronary artery fistulae are treated, and the coronary arteries are undamaged.