Introduction
Nail guns had been widely used in the industrial field due to the effectiveness and time saving properties [1], but the lack of proper training resulted in numerous body injuries mainly in peripheries [2]. However, heart related nail gun injuries are rare and mostly to the right chambers of the heart [3]. The majority of cases ended up with good outcomes despite their acute presentations to the ED. This favorable prognosis is mainly attributed to the presence of experts who will guide the management approach starting from the preoperative imaging and surgical intervention. We present a rare case of a chronic nail gun injury to the left ventricle with formation of coronary-pulmonary artery fistula.