This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by O'Leary, E. L. Articles by McCall, D. Search for Related Content PubMed PubMed Citation Articles by O'Leary, E. L. Articles by McCall, D.

(Circulation. 1998;98:487-488.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Vieussens' Ring

Edward L. O'Leary, MD; Luis Garza, MD; Michael Williams, MD; ; David McCall, MD, PhD

From the University of Texas Health Science Center at San Antonio. Dr O'Leary is now at the University of Nebraska Medical Center.

Correspondence to Edward L. O'Leary, MD, Assistant Professor, Division of Cardiology, University of Nebraska Medical Center, 600 S 600th St, Omaha, NE 68198-2265.

A 63-year-old man presented with a 2-week history of bilateral lower-extremity edema, a 30-lb weight gain, increasing shortness of breath, and paroxysmal nocturnal dyspnea. Past medical history was significant for an initial episode of congestive heart failure in March 1995. A subsequent cardiac catheterization at that time showed a 90% occluded ostial left main coronary artery with high-grade lesions involving the mid left anterior descending (LAD) and circumflex arteries. Coronary artery bypass graft surgery was performed with a left internal mammary artery (LIMA) graft to the LAD and a saphenous vein graft to an obtuse marginal artery. The patient was referred for cardiac catheterization on this admission. An AL-1 catheter could not be successfully engaged into the left main artery and was subsequently directed toward the right coronary artery. There was no damping of the arterial waveform upon engagement. Two sets of biplane images in different projections showed this to be a 3.3-mm (by quantitative angiography) conus branch off the right coronary artery. It passed upward and over the right ventricular outflow tract to provide collateral flow to the LAD and subsequently the other vessels of the left coronary artery system. This type of collateral system is known as Vieussens' ring. Competitive flow was seen at the site of the LIMA-to-LAD anastomosis.

View larger version (114K): [in this window] [in a new window]   Figure 1. Top, A 60° left anterior oblique view. LAD indicates left anterior descending coronary artery; RI, ramus intermedius; Cx, circumflex; LM, left main; RCA, right coronary artery; solid arrow, conus-LAD bifurcation; and open arrow, conus-RCA bifurcation. The left internal mammary artery can be faintly seen filling in retrograde in the mid LAD. Bottom, A 30° right anterior oblique view. Abbreviations as in top panel.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.

This article has been cited by other articles:

				M. W. Hansen and N. Merchant Vieussens' Ring: Combining Computed Tomography Coronary Angiography and Magnetic Resonance Imaging in Assessing Collateral Pathways Circulation, October 17, 2006; 114(16): e545 - e546. [Full Text] [PDF]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by O'Leary, E. L. Articles by McCall, D. Search for Related Content PubMed PubMed Citation Articles by O'Leary, E. L. Articles by McCall, D.