Internal mammary artery-to-pulmonary artery fistulas. Case report and review of the literature.

A case of internal mammary artery-to-pulmonary artery fistula is presented, and all previously reported cases are reviewed. This represents a rare cause of a continuous precordial murmur that may be confused clinically with a patent ductus arteriosus. Patients are usually asymptomatic, and routine diagnostic tests may be of little help in establishing a diagnosis. Selective internal mammary angiography is the procedure of choice for confirmation and localization. The question of advisability of surgery for these patients remains unanswered.