“…Other rare complications reported were myocar dial ischaemia, infective endocarditis, or rupture of the aneurysm [7], Although it seems clear that symptomatic patients with large communica tions should have their fistulae closed, the role of surgery in asymptomatic patients remains uncertain [19]. Closure can be done by simply ligating the fistula at its point of entry into the receiving chamber as was done in our case I. Alternatively, extracorporeal circulation may be used to achieve clo sure of the coronary artery fistula either from inside the involved chamber or via an arteriotomy, directly over the site of fistula [11], Many cases of successful operations involving coronary fistulae draining both into the right as well as the left side of the heart have been reported in the literature [7,11,20], Due to the presence of multiple fistulae involving all three major coronary arteries in our case 3, and the left anterior, descending and circum flex artery in our case 4, it was elected not to advise operation because of the great difficulties in ligating all the abnormal communicating channels to the left ventricle.…”