An 63-year-old male presented with effort angina for 6 months’ duration. His computed tomography coronary angiogram showed tripple vessel coronary artery disease with tortuous dilated collaterals connecting conus branch of the right coronary artery (RCA) as well as separately from the proximal part of RCA with septal branch of the left anterior descending (LAD) artery, suggestive of Vieussens’ ring [Figure 1].
Figure 1.
Tortuous dilated collaterals connecting conus branch of the right coronary artery with septal branch of the left anterior descending artery, suggestive of Vieussens’ ring
He underwent transfemoral coronary angiography, which showed similar findings [Video 1]. He underwent LAD artery coronary fistula embolization followed by percutaneous transluminal coronary angioplasty (PTCA) to LAD, left circumflex artery-the first obtuse marginal artery, and RCA coronary fistula occlusion followed by PTCA to RCA. Vieussens’ arterial ring (VAR) is widely described as a collateral pathway between the conus branch of the RCA and the proximal right ventricular branch of the LAD coronary artery.[1,2]
VAR does not form only due to CAD; it could also develop as a result of congenitally hypoplastic CAD.[3] The existence of collateral circulation is crucial in patients with ischemic heart disease.[4] The connection between the conus branch and the LAD (VAR) may provide adequate circulation to either the left or right coronary arterial system, allowing patients to survive even during myocardial infarctions.
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The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
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