Successful surgical occlusion of a left anterior descending coronary artery-to-right ventricular fistula through a minimally invasive route is described. The fistula was ligated epicardially through a small midline pericardial window created in the xiphisternum without myocardial dissection, cardiac arrest, or cardiopulmonary bypass. Intraoperative transesophageal echocardiography played a crucial role in locating the site of the fistula, thereby allowing a minimally invasive surgical approach and assessment of the adequacy of repair.
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