Twenty-two patients underwent surgical treatment of coronary artery fistulas. The right coronary artery was the most common vessel of origin (68.2%), and the most frequent drainage site was the right ventricle (45.4%). The operation was performed with the use of extracorporeal circulation in 21 patients. Only one patient underwent distal ligation without the use of extracorporeal circulation. The absence of operative mortality and severe postoperative complication provide clear indications for surgical treatment. In view of currently improved and standardized techniques of extracorporeal circulation, we believe that it should be employed routinely.