Objective To analyze the characteristics of prenatal ultrasound images of congenital coronary artery fistula and summarize its prognosis and outcome. Methods The clinical information and ultrasonic data of 7 fetuses with congenital coronary artery fistula in our hospital were analyzed retrospectively. The prenatal ultrasound findings were summarized and the clinical outcomes were followed up. Results Among the 7 fetuses with congenital coronary artery fistula diagnosed by prenatal ultrasound, 3 cases had isolated coronary artery fistula and 4 cases had other malformations; 4 cases were left coronary artery fistula and 3 cases were right coronary artery fistula. Two-dimensional ultrasound findings: in 7 cases, the involved coronary arteries were detected at the aortic root of the left ventricular outflow tract, showing different degrees of widening and expansion, with an internal diameter of 2.5-4.4 mm; In 2 cases, the left and right hearts were asymmetric and the left heart was small, while the other 5 cases were symmetrical. CDFI findings: abnormal tubular turbulent blood flow signals were detected in the aortic root or atrioventricular sulcus of 7 fetuses. Clinical outcome: 2 cases of isolated coronary artery fistula had good postoperative results; One case died at 37 weeks of gestation complicated with pulmonary artery stenosis, ventricular septal defect, and pericardial effusion, and the fetus; 4 cases were induced labor. Conclusion When using prenatal ultrasound to detect abnormal and obvious tubular blood flow signals in the aortic root or atrioventricular sulcus, it is necessary to be alert to the possibility of coronary artery fistula after tracing its origin, shape, and endpoint, which has important clinical value for the early treatment of the fetus after birth.