Vol 30, No 2 (2023)
Image in Cardiovascular Medicine
Published online: 2023-04-17

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Vieussens’ arterial ring: A blessing and a curse

Maciej T. Wybraniec123, Wojciech Wróbel12, Małgorzata Cichoń12, Łukasz Dykas4, Katarzyna Mizia-Stec123
Pubmed: 37083171
Cardiol J 2023;30(2):331-332.

Abstract

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clinicAL CARDIOLOGY

IMAGE IN CARDIOVASCULAR MEDICINE

Cardiology Journal

2023, Vol. 30, No. 2, 331–332

DOI: 10.5603/CJ.2023.0022

Copyright © 2023 Via Medica

ISSN 1897–5593

eISSN 1898–018X

Vieussens’ arterial ring: A blessing and a curse

Maciej T. Wybraniec123Wojciech Wróbel12Małgorzata Cichoń12Łukasz Dykas4Katarzyna Mizia-Stec123
1First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
2Upper-Silesian Medical Center, Katowice, Poland
3Member of the European Reference Network on Heart Diseases – ERN GUARD-HEART
4Department of Radiology, Upper-Silesian Medical Center, Katowice, Poland

Address for correspondence: Maciej T. Wybraniec, MD, PhD, Associate Professor, First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul. Ziołowa 47, 40–635 Katowice, Poland, tel: +48 32 359 88 90, fax: +48 32 2523032, e-mail: maciejwybraniec@gmail.com

Received: 20.09.2022 Accepted: 9.12.2022

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

A 43-year-old premenopausal female patient was admitted to the cardiology department with typical clinical presentation of non-ST-segment elevation acute myocardial infarction (MI), without overt electrocardiographic signs of ischemia or regional wall motion abnormalities. Coronary angio­graphy (CAG) revealed non-obstructive coronary arteries with the presence of tortuous and prominent conus artery (Fig. 1A), with a small collateral reaching left coronary artery (LCA). Also, the selective CAG of LCA revealed two small collaterals stemming from proximal part of left anterior descending artery (LAD) forming a closed arterial ring (Fig. 1B). Computed tomography angiography revealed presence Vieussens’ arterial ring with connection between conus artery and LAD (Fig. 1CE). Subsequent cardiac magnetic resonance showed MI scar reflected by transmural late gadolinium enhancement in mid inferolateral segment of the left ventricle (Fig. 1F, T1-sequence). Given the diagnosis of MI, dual antiplatelet therapy and transient treatment of low-molecular weight heparin was instituted leading to an uneventful in-hospital stay. Outpatient myocardial dipyridamole-stress dynamic single photon emission tomography excluded ischemia within any left ventricular segment, while the patient complained of chronic angina of Canadian Cardiovascular Society grade 2. Vieussens’ arterial ring is a rare congenital anomaly of coronary arteries, which was previously associated with collateral circulation in the event of occlusion or agenesis of LCA. This case indicates the association between presence of Vieussens’ arterial ring and MI with non-obstructive coronary arteries. The underlying mechanism remains unknown but myocardial steal phenomenon or embolization from in-situ thrombosis within the Vieussens’ ring collaterals could explain the present finding.

Figure 1. Vieussens’ arterial ring on multimodality imaging; A. Selective coronary angiography of prominent conus branch from right coronary artery, RAO 30, CAU 15, arrow conus branch with a collateral forming Vieussens’ arterial ring; B. Coronary angiography of left coronary artery, RAO 30, CAU 15, arrows collaterals of the Vieussens’ ring; C, D, E. Computed tomography angiography revealed presence of vascular ring of Vieussens with connection between conus artery and left anterior descending artery (arrow); F. Cardiac magnetic resonance, T1-sequence, arrow transmural late gadolinium enhancement in mid inferolateral segment of the left ventricle.
Conflict of interest: None declared