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Updated: Mar 23, 2026
Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
Anatomical Consideration and Potential Complications of Coronary Sinus Catheterisation
Lalit Mehra1, Shashi Raheja2, Sneh Agarwal3
1Senior Resident, Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India .
Insights
Anatomical study of coronary sinus and Great Cardiac Vein in 40 cadaveric hearts reveals Thebesian valve obstruction in 12.5% of cases, impacting coronary venous catheterization success.
Area of Science:
- Cardiac anatomy
- Interventional cardiology
- Vascular access
Background:
- Coronary venous catheterization is crucial for cardiac interventions.
- Potential obstructions include the Thebesian valve and Great Cardiac Vein (GCV) bend.
- Understanding these anatomical factors is key to procedural success.
Purpose of the Study:
- To detail anatomical considerations for coronary venous catheterization.
- To identify causes of obstruction and potential complications.
- To provide data for optimizing catheter selection and technique.
Main Methods:
- Dissection of coronary sinus and GCV in 40 adult cadaveric hearts.
- Measurement of dimensions (length, diameter) and angles.
- Assessment of Thebesian valve morphology and ostial coverage.
- Description of anatomical relationships with adjacent arteries.
Main Results:
- Coronary sinus: length 35.35±4.43 mm, diameter 11.75±2.66 mm.
- Great Cardiac Vein (GCV): length 96.23±22.52 mm, diameter 5.99±1.02 mm, angle of bend 107±6.74 degrees.
- Thebesian valve: absent in 3 hearts, varied morphologies, covered >50% of ostium in 5 hearts (12.5%).
Conclusions:
- Coronary sinus and GCV dimensions aid in selecting appropriate catheter size and length.
- Significant Thebesian valve coverage (12.5%) can obstruct catheterization.
- GCV's obtuse angle requires careful navigation; adjacent artery compression can cause ischemia.
Introduction:
Coronary venous catheterisation has been used for performing various cardiologic interventions. The procedure might become complicated due to obstruction offered by the valve of coronary sinus (Thebesian valve) the acute bend of the Great Cardiac Vein (GCV). The present study sought to expound the anatomical considerations of coronary venous catheterization and to elucidate the potential causes of obstruction and the complications of this procedure.
Materials And Methods:
In this cross-sectional observational study, coronary sinus and GCV were dissected in 40, formalin fixed, adult cadaveric human hearts. Course, length, diameter and angle of bend of GCV, length of coronary sinus and its diameter at its ostium in right atrium were recorded. Thebesian valve morphology and percentage coverage of coronary sinus ostium was recorded. Relation of the coronary sinus and GCV with their neighbouring arteries was described.
Results:
Coronary sinus: near its termination was directly related to the left atrium. Length: 35.35±4.43 mm (1 SD). Diameter: 11.75 ± 2.66mm. Diameter of CS ostium was more in hearts where Thebesian valve was absent. GCV travelled superficial or deep to the left diagonal artery and crossed circumflex artery superficially. Length: 96.23 ±22.52mm. Diameter: 5.99 ±1.02mm. Angle of bend: 107 ±6.74 degrees. Thebesian valve: Absent in 3 hearts. Various morphologies were observed: thin band, thin band with fenestrations, broad band with fenestrations, well developed semilunar valve (Thin/thick). In five hearts, valve covered more than 50% of coronary sinus ostium.
Conclusion:
Coronary sinus and GCV diameter will help cardiologists and cardiothoracic surgeons to choose an appropriate sized catheter and their length will decide the length of catheter advancement. Thebesian valve may cause obstruction to the catheter due to an extensive coverage of coronary sinus ostium, which is seen in 12.5% cases. The obtuse angle of GCV has to be negotiated in order to enter this vessel. Arteries lying deep to coronary sinus and GCV might be compressed leading to myocardial ischemia.
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