Coronary artery fistulas can occur in patients who survive cardiac trauma. We report one such case with development of a right coronary artery-right atrial fistula 2 years after injury. The literature shows that surgical correction should be performed before the development of incapacitating symptoms (angina, pulmonary hypertension, congestive heart failure). Proximal and distal ligation of the affected coronary artery with distal bypass grafting is the recommended surgical procedure. Other procedures have led to recurrence of the fistula.