Chapter category: Heart
The Anatomical Basis of Coronary Sinus Reperfusion
Coronary Sinus Intervention in Cardiac Surgery, Second Edition
Edited by: Werner MohlISBN: 1-58706-006-X
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Chapter authors:
Michael von Lüdinghausen, Masahiro Miura
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The venous drainage system of the myocardium is divided in two parts (Fig. 1):
A. The great (major) cardiac venous drainage system (GCVDS) extends over the surface of the ventricular and atrial myocardium. The distribution patterns of these veins are highly variable; however, the strongest veins drain the left ventricular myocardium and empty into the coronary sinus (cs).
B. The small (minor) cardiac venous drainage system (SCVDS) is found in a subendocardial location in the innermost myocardial layers of the cardiac walls.These very short cardiac veins have an ostial diameter of less than 1 mm; in the adult they represent the primitive supply and drainage system of the spongeous myocardium that was carried out by endocardialy-sinusoidal vessels usually connected to the next chamber in the embryo.
A. The GCVDS consists of six intercommunicating parts (Fig. 2a, 2b):
- the cs and its ventricular tributaries
- the cs and its left atrial tributaries
- the remaining left atrial veins
- the superior septal veins (including the venous drainage of the atrioventricular node)
- the anterior cardiac venous system
- the right atrial veins (including the venous drainage of the sinus node)
B. The SCVDS consists of four types of (Thebesian) vessels (Figs. 3, 4) extending from a subendocaridal origin:
- the arterio-sinusoidal vessels
- the arterio-luminal vessels
- veno-sinusoidal vessels
- veno-luminal vessels
Characteristic morphology of tributaries of the GCVDS: the veins frequently cross interventricular, coronary and interatrial sulcuses; they exhibit intramurally-widened terminal spaces, collectors, or sinuses; the venous openings into the right and left atrium have ostial valves.7,11 The characteristic pattern of the Thebesian vessels will be described in a further report.
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