Correspondence Address:
Dr. Atul Kaushik
Department of Cardiology, AIIMS, Jodhpur, Rajasthan
India

Full Text

A 65-year-old man with a positive family history of coronary artery disease and no other known risk factors came to the outpatient department with complaints of atypical angina for the past 6 months. His cardiovascular examination was unremarkable with T-wave inversion in inferior leads in electrocardiography. He underwent cardiac computed tomography (CT) that showed vascular communication between the proximal left anterior descending artery (LAD) and small conal branches of the right coronary artery (RCA) suggestive of Vieussens' arterial ring (VAR) [[Figure 1], marked with long thin white arrow]. The patency of the arterial ring was further confirmed on a diagnostic coronary angiogram with opacification of RCA in selective left coronary angiogram [Video 1] and [Video 2].{Figure 1}

[SUPPORTING:1]

Video 1: Selective left coronary angiogram shows VAR between proximal LAD and small conal branch of RCA. There is opacification of RCA during the left coronary angiogram. LAD: Left anterior descending artery, RCA: Right coronary artery, VAR: Viessuens' arterial ring.

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Video 2: Selective right coronary angiogram shows a blush of contrast within the Vieussens' arterial ring supplied by small conal branches. The left coronary artery is not opacified.

VAR refers to the persistence of congenital collateral between the conal artery and the LAD. It was first described by Raymond de Vieussens in 1706 and was named after him later in the 19th century. It has many subtypes[1] and type I, as seen in our case, is not associated with other coronary anomalies. As the pressure in the left and right coronary arteries is equal, under normal circumstances, no flow is detected in the VAR. If stenosis develops in any of the systems, the vessel becomes prominent and allows the blond flow to the low-pressure system.[2] In our case, the predominant direction of flow was from LAD to RCA; however, no obvious stenosis was detected in the RCA or its branches on CT as well as coronary angiogram. The significance of flow direction in VAR to predict future stenosis is not known. Thus, this normal variant is important to diagnose and as imaging of this arterial ring may be difficult, cardiac CT may provide highly accurate images of this rare anomaly and should be supplemented with coronary angiograms in doubtful cases.[1],[3]

Ethical considerations

Informed consent was obtained from the patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References