Coronary artery fistula is most often a congenital condition (present at birth) in which one of the arteries of the heart is abnormally formed. The fistula forms when there is an abnormal connection between one of the coronary arteries (vessels that supply blood to the heart) and a heart chamber or with another blood vessel. Coronary fistulas are rare and sometimes associated with other congenital heart defects. In most cases, there are no symptoms, but when symptoms are present, they usually include chest discomfort, fatigue, fast or irregular heartbeats (heart murmurs), and shortness of breath. This condition can also occur after birth due to certain types of heart surgery, injuries to the heart, or an infection that weakens the heart or arteries. Coronary artery fistula is usually not diagnosed until later in life or during the presence of another heart disease. Sometimes it is diagnosed early if the baby has a heart murmur that requires further investigation. Diagnosis can be made by an angiogram (x-ray of the heart using dye to see blood flow pattern), echocardiogram, MRI or a heart catheter. If the fistula is small, it may not need to be treated as it may heal on its own. Larger fistulas may require corrective surgery. Other procedures may be available as well. Children who have surgery often do very well and only a small number may need a second surgery. Normal lifespan is expected when the fistula is an isolated finding. If you or your child has been diagnosed with a coronary artery fistula, please consult your doctor to discuss the most current treatment options.