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Coronary arterial anatomy: Normal, variants, and well-described collaterals
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
John P. Erwin, Evan L. Hardegree, Gregory J. Dehmer
There is considerable variability in cardiac venous anatomy, but there are some consistent venous struc- tures (Figure 16.7).[28] The most notable of these is the great (or anterior) cardiac vein, which begins at the apex of the heart and ascends along the anterior interventricular groove to the base of the ventricles parallel to the LAD. It connects with diagonal veins draining the lateral and anterolateral portion of the LV and turns posterior at the left atrioventricu- lar groove, wrapping around the left side of the heart parallel to the LCx coronary artery.[29] In addition to several smaller tributaries from the left atrium and ventricles, the great car- diac vein receives two main branches, the large left marginal vein along the lateral border of the heart and the posterior LV branch (also known as the posterolateral branch). The great cardiac vein terminates in the coronary sinus, a junc- tion defined by the presence of the left atrial oblique vein. This transition point is usually marked by the presence of intravenous valves, which can obstruct catheter and pace- maker lead placement. Another fairly consistent branch is the middle cardiac vein, which runs in the posterior interven- tricular groove, parallel to the posterior descending coronary artery. Of all of the branches of the coronary venous system, the great cardiac and middle cardiac veins are the two most consistently present branches seen in more than 90% of individuals.[30] However, unlike the middle cardiac vein, the great cardiac vein varies considerably in its course.[31] Lateral and posterior venous branches together are seen in less than 50% of human hearts.
Coronary Sinus Defect, Premature Restriction of Foramen Ovale and Cysto-Colic Peritoneal Band
Published in Fetal and Pediatric Pathology, 2023
The coronary sinus is the most constant feature of the cardiac venous system [16–18], and of all of the branches of the coronary venous system, the great cardiac and middle cardiac vein [19] and posterior cardiac veins are the ones present most consistently [17]. Many of the these major cardiac veins anastomose and two rather constant venous anastomotic rings have been described [17]. The larger and more constant anastomotic ring (90%) connects the ends of the middle and great cardiac veins and the less constant (70%) ring connects the ends of the posterior and left marginal veins with a branch of the middle cardiac vein [17]. All the major veins also receive inconstant albeit innumerable, smaller branches, which contribute to an anastomotic network of veins in the epicardium [17]. Without the persistent left superior vena cava and left hypoplastic heart and in the absence of coronary sinus, it is tempting to speculate that the direct drainage of the major cardiac veins and their anastomotic channels into the left heart may have contributed to hemodynamic forces potentiating the closure of the foreman ovale (Fig. 2).