“…1,2,6 Asymptomatic coronary cameral fistulas without evidence of chamber enlargement, ventricular dysfunction, coronary ischemic steal, or arrhythmias can be monitored every three to 5 years. If there are symptoms of ischemia on exercise stress testing, progressive cardiac chamber enlargement or ventricular dysfunction, or new arrhythmias related to the fistula, closure is recommended 7,8 (Figure 5). The advancement of transcatheter approaches has led to the ability to successfully reduce the burden of symptomatic coronary cameral fistulas with coil embolization or other occlusion devices.…”