Methods: Fourteen patients who were referred to pediatric cardiology clinic with a coronary artery fistula, anomalous origin of left coronary from pulmonary artery, and anomalous origin of right coronary artery from pulmonary artery between January 2009 and March 2015 were retrospectively analyzed. Ten patients with a coronary artery fistula were grouped as group 1, and four patients with anomalous origin of left coronary from pulmonary artery and anomalous origin of right coronary artery from pulmonary artery as group 2. Most of the patients were evaluated for chest pain with murmur on physical examination. Three patients underwent transcatheter and one patient surgical procedure. One patient indicated for surgery did not accept treatment and was followed in the outpatient setting with the other five patients who did not need any intervention. Patients in group 2 underwent surgery.

Results: The patients who underwent treatment were discharged from hospital without any problem. Acetylsalicylic acid was given to the patients in group 1 following the intervention. One patient used also warfarin for persistent dilatation of the proximal right coronary artery. Group 2 patients had improved clinical findings during follow-up.

Conclusion: Coronary artery fistulas, anomalous origin of left coronary from pulmonary artery, and anomalous origin of right coronary artery from pulmonary artery can be easily overlooked during echocardiographic evaluation. Therefore, further imaging modalities may be needed. Transcatheter approach is a safe alternative to surgical therapy in the treatment of fistulas. Arterial reimplantation technique is successful in anomalous origin of left coronary artery from pulmonary artery and anomalous origin of right coronary artery from pulmonary artery surgery. Echocardiography has the main role in identifying these rare, but critical conditions.