DEVELOPMENT OF A FISTULA BETWEEN AN INTERNAL MAMMARY ARTERY GRAFT ANDTHE PULMONARY VASCULATURE FOLLOWING CORONARY-ARTERY BYPASS-GRAFTING -REPORT OF A CASE

We report herein the rare case of a 56-year-old man who gradually deve loped congestive cardiac failure 6 months after undergoing coronary ar tery bypass grafting and was found to have a fistula between the inter nal mammary artery and the pulmonary artery of the upper lobe diagnose d by selective left internal mammary arteriogram. A second sternotomy was performed and demonstrated dense adhesion between the fissure surr ounding the internal mammary artery and the upper lobe, and the fistul a was resected. We believe that the patient's increasing cardiac failu re was almost certainly caused by coronary steal.