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Images In Cardiology
Published online: 2019-07-02
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“Vieussens ring”- an unusual form of inter-coronary collateral from conus artery to diagonal artery

Santosh Kumar Sinha, Mahmodula Razi, Anupam Singh, Kumar Himanshu, Puneet Aggarwal
DOI: 10.5603/FC.a2019.0075

open access

Ahead of print
Images In Cardiology
Published online: 2019-07-02

Abstract

In patients with critical stenosis or total occlusion of either the left anterior descending artery or right coronary artery, the conus branch of right coronary artery sometimes serves as a major source of inter-coronary collateral. These collateral channels form the Vieussens ring. Here we report a case of a 74-year-old diabetic and hypertensive male whose angiogram revealed normal appearing left main, discrete lesion with critical stenosis of proximal left circumflex (LCx), left anterior descending artery (LAD) revealing diffuse disease of mid segment with critical stenosis and dissection, and chronic total occlusion of right coronary artery. However, diagonal branch could not be visualized. The large and tortuous conal branch was filling the large diagonal branch of LAD. In our case, Vieussens ring was serving as collateral to diagonal branch instead of LAD. It has both diagnostic, as well as therapeutic implication as it helps surgeon to avoid any inadvertent damage to the conus artery especially if surgery involves manipulation of the right infundibulum. It may serve as an alternative to the retrograde route when the lesion cannot be successfully crossed using an anterograde approach for LAD recanalization.

Abstract

In patients with critical stenosis or total occlusion of either the left anterior descending artery or right coronary artery, the conus branch of right coronary artery sometimes serves as a major source of inter-coronary collateral. These collateral channels form the Vieussens ring. Here we report a case of a 74-year-old diabetic and hypertensive male whose angiogram revealed normal appearing left main, discrete lesion with critical stenosis of proximal left circumflex (LCx), left anterior descending artery (LAD) revealing diffuse disease of mid segment with critical stenosis and dissection, and chronic total occlusion of right coronary artery. However, diagonal branch could not be visualized. The large and tortuous conal branch was filling the large diagonal branch of LAD. In our case, Vieussens ring was serving as collateral to diagonal branch instead of LAD. It has both diagnostic, as well as therapeutic implication as it helps surgeon to avoid any inadvertent damage to the conus artery especially if surgery involves manipulation of the right infundibulum. It may serve as an alternative to the retrograde route when the lesion cannot be successfully crossed using an anterograde approach for LAD recanalization.

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Keywords

Chronic total occlusion; Conus branch; Diagonal artery; Vieussens ring;

About this article
Title

“Vieussens ring”- an unusual form of inter-coronary collateral from conus artery to diagonal artery

Journal

Folia Cardiologica

Issue

Ahead of print

Published online

2019-07-02

DOI

10.5603/FC.a2019.0075

Keywords

Chronic total occlusion
Conus branch
Diagonal artery
Vieussens ring

Authors

Santosh Kumar Sinha
Mahmodula Razi
Anupam Singh
Kumar Himanshu
Puneet Aggarwal

References (4)
  1. Levin DC, Beckmann CF, Garnic JD, et al. Frequency and clinical significance of failure to visualize the conus artery during coronary arteriography. Circulation. 1981; 63(4): 833–837.
  2. Yamagishi M, Haze K, Tamai J, et al. Visualization of isolated conus artery as a major collateral pathway in patients with total left anterior descending artery occlusion. Cathet Cardiovasc Diagn. 1988; 15(2): 95–98.
  3. Vilallonga R. Anatomical variations of the coronary arteries: I. The most frequent variations. Eur J Anat. 2003; 7: 29–41.
  4. Tanigawa J, Petrou M, Di Mario C. Selective injection of the conus branch should always be attempted if no collateral filling visualises a chronically occluded left anterior descending coronary artery. Int J Cardiol. 2007; 115(1): 126–127.

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