Coronary artery fistulas (CAFs) are rare coronary anomalies, congenital or acquired, usually asymptomatic, diagnosed incidentally with cardiac imaging. The case of a patient who initially was suspected for a coronary atherosclerotic disease is described. However, an unexpected finding presented by the performed coronary angiography, surprisingly led to a different diagnosis. A caramel fistula connecting the first diagonal coronary artery (D1) and the left ventricle. The patient was finally referred for surgery.
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