A precious ring: Vieussens’ ring and left main coronary artery atresia – a case report

Introduction

Atresia of the left main coronary artery (LMCA) refers to a congenital defect in which both the LMCA and its coronary ostium fail to develop, despite the presence of anatomically normal left anterior descending and circumflex branches. This condition is exceedingly uncommon, with fewer than 60 documented instances reported globally over the past 70 years [1]. In cases of LMCA, the existence of Vieussens’ arterial ring – a connection forming a circular anastomosis between the conus branch of the right coronary artery and the left anterior descending artery (LAD)—provides an alternative pathway for perfusion of the otherwise isolated left coronary circulation. This represents a very rare coronary anomaly. Only 7 case reports describing the combination of Vieussens’ ring and left main atresia are documented in the literature [2].

Publication History

Received: 25 June 2025

Accepted after revision: 21 August 2025

Article published online:
08 September 2025

• Literature

• 1 Yassin AS, Dayco J, Kottam A. Left Main Coronary Artery Atresia: Diagnostic Images of a Rare Coronary Anomaly. Mayo Clin Proc 2023; 98: 655-656
• 2 Christodoulou KC, Stakos D, Androutsopoulou V. et al. Vieussensʼ Arterial Ring: Historical Background, Medical Review and Novel Anatomical Classification. Cureus 2023; 15: e40960
• 3 Koh E, Nakagawa M, Hamaoka K. et al. Congenital atresia of the left coronary ostium: diagnosis and surgical treatment. Pediatr Cardiol 1989; 10: 159-162
• 4 Raju V, Hebbale RC, Muniswamy CS. et al. True congenital atresia of the left main coronary ostium: delayed presentation. Asian Cardiovasc Thorac Ann 2018; 26: 54-56
• 5 Alsalehi M, Jeewa A, Wan A. et al. A case series of left main coronary artery ostial atresia and a review of the literature. Congenit Heart Dis 2019; 14: 901-923