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. 1C–E). 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.
Vieussens’ arterial ring: A blessing and a curse
, 12, 12, 4, 123
Abstract
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
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.
