Objective: Congenital coronary artery fistulas (CAF) are uncommon abnormalities that are known as abnormal communications between a coronary artery and a cardiac chamber or a major vessel. Incidence of CAF ranges between 0.1% and 0.2% 2 in literature, however, there is no detailed data on the incidence of CAF in a Turkish population. In this article, we evaluated the clinical manifestations, symptoms, chosen treatment strategies, and long term follow- up results of CAF in Turkish adult population. Material and Methods: In this multicenter study carried out between 2001 and 2009, a total of 25 400 angiograms which were taken for various reasons were evaluated retrospectively. Sex, age, clinical manifestations, symptoms, number of the fistulas, chosen treatment strategies, and long term follow up results of the study population were recorded and analyzed. Results: CAF were found in 32 of these cases (0.13%). Eighteen of the cases were males, and 14 were females with a median age of 57.6 years. Fifteen cases had surgery, graft-stent was applied to two cases and coil embolization was preferred in two cases. Thirteen cases were followed up under medical treatment. Graft stents were occluded after 4 and 6 months following implantation in left anterior descending artery in both cases, and hence, these patients required surgery. Mean follow-up period was 48 ± 27 months. All cases were asymptomatic (at the end of the follow-up period) and were doing well. Conclusion: In conclusion, incidence of CAF was found as 0.13% in the study population, and surgical treatment and coil embolization were considerably successful compared to stent graft application in CAF patients. © 2011 by Türkiye Klinikleri.