BackgroundTranscatheter closure of coronary artery fistulae (CAF) has emerged as an alternative to surgery, but there are no long‐term outcome results.ObjectiveWe report immediate and long‐term results in 24 patients after transcatheter closure of congen‐ ital CAF.MethodsA total of 24 patients aged 5 to 56 years old with congenital CAF underwent attempted percutaneous transcatheter closure using various devices between November 1998 and August 2008. The immediate closure results and clinical follow‐up were reviewed.ResultsOf the 24 patients, 20 (83.3%) underwent successful transcatheter closure using various devices. An angiogram right after device deployment revealed complete occlusion in 15 patients (75%) and trivial‐ to mild‐ residual flow in 5 patients (25%). Four patients (20%) had transient ST‐T wave changes after the procedure. The left ventricular end‐diastolic volume decreased from 165±31.4 mm3 to 128.6±24.4 mm3 (P = 0.012) 24 hours after procedure, and the cardiothoracic ratio from 0.57±0.02 to 0.53±0.01 (P = 0.003). Follow‐up was 100% complete and ranged from 3 months to 10 years. There were no early or late deaths. All patients were asymptomatic with complete closure of CAF except 1 patient (5%) who had a recurrence of shunt at 6‐month follow‐up, which was re‐closed by percutaneous technique.ConclusionTranscatheter closure of CAF is feasible and safe in anatomically suitable vessels and is a promising alternative to surgery in most patients. Copyright © 2009 Wiley Periodicals, Inc.