Myocardial bridging with milking phenomenon

Case contributed by Dr Dachani Kansan Naider

Presentation

Dyspnea on exertion. Past medical history of diabetes mellitus and hypertension.

Patient Data

Age: 65 years
Gender: Male

Coronary angiogram

ct
  • Myocardial bridging associated with the mid left anterior descending artery distal to the second diagonal branch
  • There is mild to moderate reduction in vessel caliber on imaging reconstructed at 75 percent of the RR interval (during ventricular diastole) - key image 1
  • This segment demonstrates severe vessel narrowing on imaging reconstructed at 34 percent of the RR interval (during ventricular systole) - key image 2
  • The remaining left anterior descending artery remains patent and can be traced distally to the cardiac apex

Key images 1 & 2

ct
  • There is mild to moderate reduction in vessel caliber on imaging reconstructed at 75 percent of the RR interval (during ventricular diastole) - key image 1
  • This segment demonstrates severe vessel narrowing on imaging reconstructed at 34 percent of the RR interval (during ventricular systole) - key image 2

Case Discussion

The caliber change during ventricular systole indicates dynamic extrinsic compression of the left anterior descending coronary artery at this level. This phenomenon is known as milking.

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