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Ann Thorac Surg 1977;24:422-429
© 1977 The Society of Thoracic Surgeons
Departments of Surgery, Radiology, and Cardiology, Montreal Heart Institute, Montreal, Que, Canada.
* Address reprint requests to Dr. Pierre Grondin, Department of Surgery, Montreal Heart Institute, 5000 E Belanger St, Montreal, Que, Canada HIT 1C8
We report 3 patients having a grade III milking effect of the proximal left anterior descending artery (LAD) and suffering from angina. Preoperative myocardial ischemia was demonstrated by stress ECG in all 3 and by pacing and lactates studies in 2. Surgical decompression of the systolically constricted artery has resulted in disappearance of angina, milking, and ischemia.
Severe milking of the LAD is a rare entity, probably congenital in origin, capable of producing myocardial ischemia and possibly causing sudden death. More studies regarding its etiology and pathophysiology are necessary. Biopsy of the myocardium surrounding the artery could be useful.
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