A study of fundamental courses in the great cardiac vein

We studied an extremely rare great cardiac vein anomaly in a 65-year-old woman during dissection practice at the Akita University School of Medicine (2013). The great cardiac vein has two main roots, one accompanied by a left marginal vein that pours into the coronary sinus, and the other ascending along the anterior interventricular sulcus from the apex, and running over the circumflex branch of the left coronary artery. It then runs along the atrial side of the transverse sinus of the pericardium, and drains directly into the superior vena cava. No anastomosis between these veins was evident. The great cardiac vein might originate from two venous systems, one in the posterior wall of the left ventricle, and the other running along the anterior interventricular sulcus. These venous systems flow in the venous network of the left edge of the coronary sulcus. The former venous system always selected the course, which went to the coronary sinus in the venous network. The latter system may drain into one of the following four courses: the first one contacts the former course; the second passes to the transverse sinus of the pericardium and flows to the (right) superior vena cava; the third passes between a pulmonary trunk and ascending aorta from the dorsum of the pulmonary trunk, turns around in a ventral aspect, and then flows into the left superior vena cava; and the fourth flows to the anterior cardiac vein. The first of these belongs to the normal great cardiac vein, but the others are anomalous.