A 72 year-old man presented with aortic pseudoaneurysm and aortopulmonary fistula, due to dehiscence of the both coronary button anastomosis, at 15 years after aortic root replacement with Carrel patch procedure for annuloaortic ectacia. At reoperation, a fistula was found on the pulmonary trunk. The pulmonary artery defect was closed with interrupted 3-0 polypropylene sutures placed through strips of Teflon felt. The left and right coronary button had completely detached from the graft. The coronary ostial hole of composite valve graft was closed using a new prosthetic patch. Two coronary artery bypass were placed on LAD and RCA using saphenous vein grafts.Coronary pseudoaneurysm with fistulization to the pulmonary artery after a modified Bentall operation is a rare complication, only a few cases has been previously reported.