Bilateral internal mammary-to-pulmonary artery fistulas after a coronary operation

A case of bilateral internal mammary artery-to-pulmonary artery fistulas presenting as recurrent angina late after revascularization is described. Objective evidence of ischemia was documented using stress electrocardiogiaphy and thallium-201 scintigraphy. The patient was managed conservatively to date with medical therapy. Fistula formation may complicate internal mammary artery bypass grafting and should be considered as a potential cause of recurrent angina.