Coronary artery fistula is rare, but the anesthesiologist may be faced with this type of patient in distinct situations. Understanding its pathophysiology is important for better perioperative management of the patient, therefore improving the prognosis.

Background and objectives: Described by Krause in 1865 1 , coronary artery fistula communicating with cardiac cavities, pulmonary artery, or coronary sinus is very rare. It represents 0.2% to 0.4% of congenital cardiopathies and 0.1% and 0.2% of the adult population undergoing coronary angiography 2. The objective of this report is to present the anesthetic management for surgical closure of a coronary fistula in an elective procedure, considering its particularities. Case report: This is a 59-year old male patient, whose coronary fistula was diagnosed during clinical investigation of progressive thoracic pain and long-standing dyspnea. The patient underwent surgical correction of coronary artery fistula under general anesthesia without extracorporeal circulation (ECC). The patient evolved without intercurrences, being discharged from the hospital with clinical improvement 7 days after surgery. Conclusions: Coronary artery fistula is rare, but the anesthesiologist may be faced with this type of patient in distinct situations. Understanding its pathophysiology is important for better perioperative management of the patient, therefore improving the prognosis.