Introduction
Coronary arteriovenous fistulas (CAVFs) are well-known, but are relatively rare cardiac anomalies with an occurrence of 0.002% of the general population.1Although approximately a quarter of all CAVFs may become aneurysmal, its spontaneous rupture with CAVFs is rare.2-6 Rupture of coronary aneurysm can be lethal because of cardiac tamponade. Herein, we discuss a successful surgical case of ruptured coronary artery aneurysm (CAA) associated with CAVFs presenting with cardiac tamponade.