Vieussens’ Arterial Ring with Coronary Artery Disease: Affecting Clinical Decision Making

Background: Incidental findings on imaging are becoming increasingly common. An example of such a finding is a Vieussens’ arterial ring. It was first described by Raymond de Vieussens as a collateral pathway between the conus branch of the right coronary artery and the proximal right ventricular branch of the left anterior descending coronary artery. This finding can be of significance in patients with coronary artery disease. Case Presentation: The authors present the case of a 79-year-old male who experienced atrial tachyarrhythmia with a complex coronary artery fistula between the left anterior descending artery, conus branch, and the main pulmonary artery, indicating a Type Ib Vieussens’ arterial ring. Type Ib means that it is accompanied by vascular pathology. The patient also had additional coronary disease in the left anterior descending artery, further increasing the complexity of the case. Conclusion: Coronary collaterals offer an alternative source of blood supply in cases of additional coronary artery disease and can impact patient prognosis. Chronic myocardial ischaemia and increased shear stresses are causes of collateral circulations. Vieussens’ arterial rings can be subdivided into four groups. Only one case report of a Type Ib Vieussens’ ring has been identified on literature review, where the patient presented with a non-ST elevation myocardial infarction, unlike the atrial tachyarrhythmia in this case. Given their rarity, specifically of Type Ib, there is increased difficulty in establishing an appropriate management pathway, thus having great impact on clinical decision making.