“…They are usually congenital, but acquired forms do occur especially in the patient to adulthood. 1,2 Their clinical importance usually in the adulthood is due to an increased risk of complications, including heart failure, myocardial ischemia, infective endocarditis, arrhythmias, and rupture . The acquired causes of coronary fistulas include coronary atherosclerosis (our patient, with diabetes, was marked by a multi district atherosclerotic disease and also coronary atherosclerotic damage, and his history showed the patient was already suffering from AMI), Takayasu arteritis, and trauma.…”