A 59-year-old man has had a heart murmur for a long time. Four years previously coronary artery-pulmonary artery fistula was diagnosed as the cause of arrhythmia, by coronary angiogram. Despite two coil embolizations some fistulae recanalized and dilated. The coronary artery connected with the main pulmonary trunk and a part of plexiform angioma on the right ventricule outflow tract. Under heart beating, we ligated the origin of each fistulae with direct closure of the ostia from inside pulmonary artery. His symptoms finally improved.
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