IJCHV-00019; No of Pages IJC Heart & Vessels xxx (2014) xxx–xxx Contents lists available at ScienceDirect IJC Heart & Vessels journal homepage: http://www.journals.elsevier.com/ijc-heart-and-vessels Letter to the Editor “Arterial circle of Vieussens” — An important intercoronary collateral Surender Deora ⁎, Sanjay Shah 1, Tejas Patel Department of Cardiovascular Sciences, Sheth V.S General Hospital, Smt N.H.L Municipal Medical College Gujarat University, Ahmedabad, Gujarat, India a r t i c l e i n f o Article history: Received 21 December 2013 Received in revised form 11 February 2014 Accepted 26 February 2014 Available online xxxx Keywords: Coronary collateral Conus artery Vieussens' ring A 66-year-old male smoker with past history of hypertension was admitted with chest pain of 8-hour duration 12-lead electrocardiogram revealed complete heart block with inverted T waves in leads V1–6 Transthoracic echocardiography revealed fair left ventricular systolic function (LVEF ~ 50%) Serum biochemistry was normal except significantly raised troponin After informed consent, coronary angiography via right transradial approach with 5F TIG catheter revealed significant stenotic lesion in mid left anterior descending (LAD) artery (Fig 1A; S Video 1) While attempting for selective right coronary artery (RCA) cannulation, TIG catheter was engaged to separately originating conus artery which revealed collaterals providing flow to LAD distal to the stenotic lesion (arrow Fig 1B; S Video 2) Right coronary artery (RCA) and left circumflex artery (LCX) were non-obstructive Patient underwent successful percutaneous coronary intervention (PCI) to LAD with TIMI III flow and spontaneously reverted to sinus rhythm on the 3rd day post-PCI Computed tomography (CT) coronary angiography delineated the course of conus artery which after an origin from the right coronary sinus passes anteriorly and superiorly to the right ventricle outflow tract towards LAD and giving collaterals to it (Fig 2A, B) This pattern of collaterals to LAD from the conus artery is known as “arterial circle of Vieussens” (or ‘Vieussens’ ring) Patient was discharged in hemodynamically stable condition and was asymptomatic at 1-month follow-up Coronary collateral circulation has an important role in the pathophysiology of coronary artery disease and is a predictor of symptoms and prognosis Vieussens' ring is a crucial coronary collateral pathway providing flow between LAD and RCA in case of significant stenotic lesion in the either of the vessel It is seen in 20% of the patients with total occlusion of LAD supplying its distal segment, [1] The presence of significant collaterals to LAD should be suspected with significant flow limiting obstruction to LAD and fairly preserved LVEF, as in our case It also has a therapeutic significance during surgery while manipulating right ventricle infundibulum and during PCI in LAD chronic total occlusion for visualizing distal LAD by simultaneous contrast injection We confirm that this report adheres to the stamens on ethical publishing as outlined in Shewan LG, Coats AJ Int J Cardiol 2012 Supplementary data to this article can be found online at http://dx doi.org/10.1016/j.ijchv.2014.02.006 References [1] Yamagishi M, Haze K, Tamai J, Fukami K, Beppu S, Akiyama T, 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;15:95–8 ⁎ Corresponding author at: Department of Cardiovascular Sciences, Sheth V.S General Hospital, Smt N.H.L Municipal Medical College, Gujarat University, Ahmedabad 380006, India Tel.: +91 8238422947; fax: +91 79 26842288 E-mail addresses: drsdeora@gmail.com (S Deora), drscshah@gmail.com (S Shah), tejaspatel@tcvsgroup.org (T Patel) Tel.: +91 9924134369; fax: +91 79 26842288 Tel.: +91 79 26466161; fax: +91 79 26842288 http://dx.doi.org/10.1016/j.ijchv.2014.02.006 2214-7632/© 2014 Published by Elsevier Ireland Ltd This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/) Please cite this article as: Deora S, et al, “Arterial circle of Vieussens” — An important intercoronary collateral, IJC Heart & Vessels (2014), http:// dx.doi.org/10.1016/j.ijchv.2014.02.006 S Deora et al / IJC Heart & Vessels xxx (2014) xxx–xxx Fig AP view of left coronary angiogram revealing significant stenotic lesion in mid LAD (panel A) AP view of separately arising conus artery giving collaterals (arrow) to mid LAD distal to the lesion (broken arrow, panel B) (AP, anteroposterior; LAD, left anterior descending artery) Fig Reconstructed 3-D VRT image of CT coronary angiography revealing the course of conus artery which after origin courses superiorly and left (panel A) towards LAD anterior to RVOT (panel B) (VRT, volume rendering technique; CT, computed tomography; LAD, left anterior descending artery) Please cite this article as: Deora S, et al, “Arterial circle of Vieussens” — An important intercoronary collateral, IJC Heart & Vessels (2014), http:// dx.doi.org/10.1016/j.ijchv.2014.02.006 ... anterior descending artery) Please cite this article as: Deora S, et al, ? ?Arterial circle of Vieussens? ?? — An important intercoronary collateral, IJC Heart & Vessels (2014), http:// dx.doi.org/10.1016/j.ijchv.2014.02.006... lesion (broken arrow, panel B) (AP, anteroposterior; LAD, left anterior descending artery) Fig Reconstructed 3-D VRT image of CT coronary angiography revealing the course of conus artery which... xxx (2014) xxx–xxx Fig AP view of left coronary angiogram revealing significant stenotic lesion in mid LAD (panel A) AP view of separately arising conus artery giving collaterals (arrow) to mid LAD