Surgical and Radiologic Anatomy

, Volume 9, Issue 2, pp 159–168 | Cite as

Clinical anatomy of cardiac veins, Vv. cardiacae

  • M. von Lüdinghausen
Original Articles

Summary

New methods of cardiological examination and treatment, such as catheterization and arterialization of the coronary sinus, venous reperfusion and cardioplegia have made necessary an exact account of the distribution pattern and the mode of opening of the cardiac veins. 350 hearts were prepared for examination with macroscopical techniques.

There are three systems of the major cardiac veins: tributaries of the coronary sinus, anterior cardiac veins, atrial cardiac veins. Their openings lie in a circle-like arrangement between the ostia of both caval veins and just above the tricuspid valve. In most cases there are variably sized intramural collecting chambers or sinuses just before the opening of all the cardiac veins. These sinuses are interpreted to favour the return of cardiac venous bloodstream from the myocardium to the right atrial cavity. The tributaries of the coronary sinus and of the anterior cardiac veins are very variable. There is for instance only in 36% of cases a small cardiac vein, which belongs to the coronary sinus system. In 64% a small cardiac vein does not exist, but its origin, the right marginal vein, joins the system of anterior cardiac veins. This behaviour diminishes the function of the coronary sinus and increases the importance of the system of anterior cardiac veins. Intramural courses of the great cardiac vein, crossing coronary arteries, ostial valves of cardiac veins, ostial valve of coronary sinus and of inferior vena cava, ostial occlusion of coronary sinus, and aneurysmlike excavation of the posterodorsal wall of the right atrium have been described also.

These facts and structures may cause morphological hindrances fo catheterization of the right atrium and coronary sinus and for reperfusion of cardiac venous drainage pathways. This report about a large conus vein, which is a great cardiac vein joining anterior cardiac veins and about intramural courses of great cardiac vein as well as semicircular venous sinuses in the wall of the right atrium is the first in the literature.

Key words

Cardiac venous systems Variability of cardiac veins Intramural courses Valves of cardiac veins Ostial occlusion of coronary sinus Anterior cardiac veins Large conus vein Intramural sinuses Atrial cardiac veins 

Aspect anatomo-clinique des veines cardiaques, Vv. cardiacae

Résumé

De nouvelles méthodes de traitement et d'investigations cardiologiques comme le cathétérisme et l'artérialisation du sinus coronaire, la revascularisation ou la cardioplégie par voie veineuse rétrograde, ont rendu nécessaire une meilleure connaissance du territoire de drainage des veines cardiaques et de leur abouchement. 350 cœurs ont été préparés et examinés macroscopiquement. Il existe trois systèmes de drainage veineux: les veines tributaires du sinus coronaire, les veines antérieures du cœur, les veines atriales. Leur abouchement se fait sur un cercle horizontal situé au-dessus de la valve tricuspide et entre les deux orifices des veines caves. La plupart du temps, il existe des dilatations veineuses, ou sinus, intra-murales, situées juste avant l'ostium veineux. Ces sinus favorisent le retour veineux dans l'atrium droit. Les territoires drainés par le sinus coronaire, et par les veines antérieures du cœur sont sujets à de nombreuses variations. La petite veine du cœur existe dans 36 % des cas seulement, elle appartient alors au système veineux du sinus coronaire. Dans 64 % des cas, il n'existe pas de petite veine du cœur, mais son origine la veine marginale droite existe, et rejoint le système des veines antérieures du cœur. Une telle disposition augmente l'importance du drainage des veines antérieures du cœur, tout en diminuant celui du sinus coronaire. Le trajet intra-mural des veines cardiaques, croisant les artères coronaires, les valvules ostiales du sinus coronaire, des veines cardiaques, et de la veine cave inférieure, l'occlusion ostiale du sinus coronaire, la dilatation anévrysmale de la face postérieure de l'atrium droit, sont des variations anatomiques qui ont toutes été décrites.

Ces différentes variations de structure sont responsables de difficultés dans le cathétérisme de l'atrium droit et du sinus coronaire ainsi que dans l'artérialisation des veines cardiaques. L'existence d'une large veine qui est en fait une grande veine cardiaque drainant les veines antérieures du cœur, d'un trajet intramural de la grande veine cardiaque, ainsi que d'un sinus semi-circulaire situé dans la paroi de l'atrium droit, comme décrits dans cet article, n'ont jamais encore été rapportés à ce jour.

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Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • M. von Lüdinghausen
    • 1
  1. 1.Anatomisches Institut der Universität WürzburgWürzburgBRD

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