The epicardial coronary collateral vessels are visualized with coronary angiography, but this method does not provide significant information about the myocardial perfusion supplied with the collaterals. In this study, myocardial contrast echocardiography (MCE) was performed to assess the coronary collaterals in 29 patients with old myocardial infarction. MCE was performed by intracoronary injection of 2 ml agitated amidotrizoate sodium meglumine. The peak background-subtracted gray level (PGL) in the infarct area was determined from the digitized echocardiographic images obtained before and after injection into the noninfarct and donor artery. PGL was compared with the 3-point coronary angiographic grades of collaterals. PGL in the infarct area was significantly lower in patients with poor collaterals than in patients with moderate to good collaterals (5 +/- 4 vs 18 +/- 8 U mean +/- standard deviation, p less than 0.01). PGL in the infarct area was less than 10 U in the 3 patients with severe asynergy despite the moderate to good collateral supply, suggesting that activity of the collaterals was not good enough to preserve the wall motion effectively. It is concluded that (1) the degree of MCE enhancement in the infarct area generally corresponded to the collateral grades assessed with coronary angiography, and (2) MCE may provide a measure of the collateral perfusion.

Coronary collaterals assessed with myocardial contrast echocardiography in healed myocardial infarction.

Functional significance of the conus artery as a collateral to an occluded left anterior descending artery demonstrated by stress echocardiography.

A 64 year-old male presented with a five month history of effort angina Non-invasive studies demonstrated preserved left ventricular function and a modest stress-induced myocardial perfusion defect at the anterior wall Coronary angiography revealed occlusion of the proximal left anterior descending coronary artery with its distal segment well supplied by collaterals branching from a left circumflex-to-main pulmonary artery fistula The occluded left anterior descending coronary artery was recanalised by percutaneous interventions, the collaterals vanished immediately, and the patient lived free of symptoms for the following five months

Left circumflex coronary-to-pulmonary artery fistula as the exclusive collateral to the occluded left anterior descending artery.

"Vieussens' ring" or "arterial circle of Vieussens" is a crucial hetero-coronaric pathway, bridging proximal right coronary artery (RCA) and left anterior descending artery (LAD) when a hemodynamically stenosis is established in the either of the vessel. In detail such coronary collateral circulation is usually supplied by branches of the conus artery. We present a case of a 62-year-old man who was admitted to our emergency department complaining of chest pain. Coronary angiography showed LAD occlusion at the mid tract with delayed and slight opacification of its distal segment sustained by Vieussens' ring. Coronary computed tomography angiography (CCTA) was subsequently performed which confirmed the presence of such natural bypass and evaluated its relationship with adjacent structures. Imaging, particularly CCTAoffers a valid tool in assessing the hetero-coronaric collateral vessel. Due to its high spatial resolution it may provide many information about the coronary anatomy by delineating their origin, course and termination. 

Vieussens' ring coronary collateral circulation: a natural bypass history.

"Vieussens' ring" or "arterial circle of Vieussens" is a crucial hetero-coronaric pathway, bridging proximal right coronary artery (RCA) and left anterior descending artery (LAD) when a hemodynamically stenosis is established in the either of the vessel. In detail such coronary collateral circulation is usually supplied by branches of the conus artery. We present a case of a 62-year-old man who was admitted to our emergency department complaining of chest pain. Coronary angiography showed LAD occlusion at the mid tract with delayed and slight opacification of its distal segment sustained by Vieussens' ring. Coronary computed tomography angiography (CCTA) was subsequently performed which confirmed the presence of such natural bypass and evaluated its relationship with adjacent structures. Imaging, particularly CCTAoffers a valid tool in assessing the hetero-coronaric collateral vessel. Due to its high spatial resolution it may provide many information about the coronary anatomy by delineating their origin, course and termination.

The relationship of patterns of collateral pathways and the functions of collaterals in patients with proximal occlusion of the left anterior descending artery (LAD) was analyzed by coronary arteriography and left ventriculography. Forty-seven patients with dominant right coronary artery (RCA) as anatomic variations had nearly the same filling areas from three major collateral pathways from the RCA to the LAD via conus branches, marginal branches, and septal perforator. The grades of collateral flows were classified as good, fair and poor according to the sizes and numbers of collateral channels, and the filling density of contrast in each collateral and three (basal, mid and apical) segments of the main trunk of the LAD. On left ventriculography in the right anterior oblique projection, the anterior wall was divided into five segments, and the regional ejection fraction in each segment was measured from end-diastolic and end-systolic areas. Three main collateral pathways and connections to the LAD were observed from the RCA. Those were the conus branches to the basal-mid LAD, the marginal branches to the mid-apical LAD, and the posterior descending branches to the basal-mid LAD via the septal perforators. Only seven patients showed normal contraction in all of the segments (Group I). In seven patients with normal contraction in the basal-mid segments and reduced contraction in the apical segment of the anterior wall, the main collateral pathways from the RCA to the LAD were the posterior descending branches via the septal perforators (Group II). In 10 patients with reduced contraction in the basal-mid segments and normal contraction in the apical segment of the anterior wall, the main collateral pathways from the RCA were the conus branches and/or the marginal branches to the LAD (Group III). In the other 23 patients with reduced contraction in entire segments (Group IV), the patterns of segmental contraction were similar to those of either Group II or Group III. These findings indicate that in the majority of cases collateral circulation from the RCA did not preserve wall contraction in all segments perfused by the occluded LAD at rest, and suggest that various patterns of segmental contraction may be influenced by the dominant of collateral pathways.

[Coronary collaterals in patients with total obstruction of the proximal left anterior descending artery: their pathways and functional significance].

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[Coronary collaterals in patients with total obstruction of the proximal left anterior descending artery: their pathways and functional significance].