Progression of the milking effect of the coronary artery.

Myocardial bridging and systolic milking may be involved in myocardial ischemia, myocardial infarction, and sudden death. We describe a patient whose milking effect progressed significantly over a two-year period. We conclude that bridging and milking effect can progress over a relatively short period. In those patients with prior reports of insignificant bridging and milking on coronary arteriograms and continued angina-like chest pain, a repeated catheterization may be warranted.

Snare retrieval of a catheter fragment with inaccessible ends from the pulmonary artery.

Frequent use of central venous lines has led to an increasing problem with embolized catheter fragments which have become lodged in the right heart and pulmonary vasculature. Removal of catheter fragments is justified because of a high complication rate when they are left in situ. Using a snare retrieval apparatus catheter fragments may be quickly and easily removed. In the past year we have seen 3 patients with embolized catheter fragments. One case was unusual in that its transverse position in the pulmonary vasculature required initial dislodgement with a pigtail catheter before it could be successfully snared. The literature and our experience suggest that most, if not all, catheter fragments in the right heart and pulmonary circulation can be successfully retrieved without resorting to thoracotomy.