Acquired coronary artery to cardiac chamber fistulas are rare. Angiographically detectable neovascularization associated with a cardiac myxoma occurs frequently. These vessels are incorporated into the atrial suture line during surgical excision. We describe the case of a patient with a symptomatic right coronary artery to right atrial fistula that had occurred 4 years after left atrial myxoma resection. These large vessels should be considered for ligation during the myxoma resection.