Congenital coronary arteriovenous fistulas represent abnormal communication between coronary arteries and any cardiac chambers, pulmonary artery, coronary sinus, superior vena cava or pulmonary vein. A 60 year-old male patient presented with severe effort-induced chest pain radiating to left arm. Resting electrocardiogram was normal and anterior ischemia was demonstrated on stress myocardial SPECT. Coronary angiogram reve-aled very long and tortuous coronary arteriovenous fistulas originated from the left circumflex and right coronary artery, which drained into intercostal arteries. Proximal segment of left anterior descending artery stenosed about 50%. Both coronary artery fistulas were ligated and left internal mammary artery was grafted into left anterior descending artery. After surgical correction he has no cardiovascular events on 7-month clinical follow-up.