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Updated: Jun 21, 2026
Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
Variations in Thebesian valve anatomy and coronary sinus ostium: implications for invasive electrophysiology
Gary S Mak1, Alexander J Hill, Florin Moisiuc
1Division of Cardiology, Department of Medicine, University of California at Irvine, 101 The City Drive South, Orange, CA 92868-4080, USA.
Insights
The Thebesian valve, guarding the coronary sinus ostium, is present in most hearts. Certain morphologies may complicate cardiac procedures requiring coronary sinus cannulation.
Area of Science:
- Cardiovascular Anatomy
- Interventional Cardiology
Background:
- The coronary sinus (CS) is crucial for cardiac procedures like device implantation and ablation.
- Understanding CS anatomy, including the Thebesian valve, is vital for procedural success.
Purpose of the Study:
- To investigate the anatomical characteristics of the human coronary sinus ostium and its Thebesian valve.
- To assess the prevalence and morphology of the Thebesian valve in human hearts.
Main Methods:
- Examined 75 autopsied human hearts.
- Measured CS ostium dimensions and characterized Thebesian valve morphology, composition, and attachment.
Main Results:
- A Thebesian valve was present in 73% of hearts.
- Hearts with Thebesian valves had significantly smaller CS ostium dimensions.
- Valve morphologies varied, with some potentially obstructing the ostium.
Conclusions:
- The Thebesian valve is a common anatomical feature in the majority of human hearts.
- A significant subset of Thebesian valves present complex morphologies that may impede coronary sinus cannulation.
- These findings have implications for electrophysiology and device implantation procedures.
Aims:
The coronary sinus (CS) is a commonly cannulated structure in patients undergoing electrophysiology studies, catheter ablation of arrhythmias, implantation of resynchronization therapy devices and, more recently, percutaneous mitral valve repair. The advent of these procedures has led to a renewed interest in the anatomy of the coronary venous system including its various components. To improve our understanding of this structure, we studied the anatomy of the human CS, including the valve that guards its ostium, the Thebesian valve.
Methods And Results:
In 75 randomly selected autopsied human hearts, we measured the transverse and craniocaudal dimensions of the CS ostium and characterized the shape, composition, per cent coverage, and attachment points of the Thebesian valve when present. Of the 75 hearts examined, 54 had organic heart disease including atherosclerotic coronary artery disease, left ventricular hypertrophy, dilated cardiomyopathy, rheumatic heart disease, infective endocarditis, and non-rheumatic valvular heart disease. A wide variety of Thebesian valve morphologies were seen, ranging from the absence of any valve to those where the valve was completely occluding the CS ostium. A Thebesian valve was present in the majority of the hearts examined (55/75 hearts-73%). The average transverse dimension of the CS ostium in hearts with Thebesian valves (7.3+/-2.8 mm) was significantly shorter than those without Thebesian valves (9.4+/-2.9 mm, P=0.005). Similarly, the average craniocaudal dimension of the CS ostium in hearts with Thebesian valves (7.9+/-2.7 mm) was also significantly shorter than those without Thebesian valves (9.3+/-2.9 mm, P=0.045).
Conclusion:
Our study shows that some form of Thebesian valve is present in the majority of hearts (>70%). Of these, a significant minority (16%) had a valve morphology (covering >75% of the ostium, a fibrous, fibromuscular, or muscular composition, and devoid of fenestrations) that makes them a 'potentially complicating' structure interfering with the cannulation of the CS.
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