Coronary artery fistulas (CAFs) are rare anomalies that connect the coronary artery to either a cardiac chamber or vein. Fistulas mostly arise from the left anterior descending artery or from the right coronary artery, and arise due to abnormalities in embryologic development. The prevalence of this condition is about 0.27–0.40 % of all congenital cardiac defects (Congenital anomalies of the coronary arteries occur in 0.4–2 % of the population.) The diagnosis is usually challenging and in most cases they are found incidentally during angiographic evaluation for coronary vascular disorder. CAFs are asymptomatic; however, they cause a wide variety of symptoms because of their hemodynamic consequences or complications. The main clinical manifestations
