Fig. 2 The use of the Trendelenburg position and the application of the Starfish™ on the apex, in order to lift the heart, enable the management of a deeply seated coronary arteriovenous fistula without cardiopulmonary bypass. The arrows indicate the location of the right coronary artery aneurysm, close to the drainage site into the coronary sinus (CS). The arrowheads point to the location of the fistula from the left circumflex artery.