Uniqueness of this case report is that though coronary Cookbook Stand cameral fistulas are itself rare, we closed fistula effectively in a different way.Since surgery was only good option available as patient had concomitant valvular disease, we closed distal end of fistula in PA and then took Coffee Machine deep bites of suture in fistulous track itself.This approach closed fistula effectively and we had no need to dissect and ligate its origin from LAD which is more arduous and dangerous task.