A rare variant of the great cardiac vein draining directly into the left atrium

Abnormalities in drainage of the GCV are interesting due to its rarity and likely to be underreported, with most cases found incidentally in cardiac imaging and autopsy studies.We report a case with anomalous drainage of the GCV into the LA, and the rest of the cardiac veins are draining normally.

A 60-year-old male presented with heart palpitations for half a month. Electrocardiogram and laboratory tests showed no abnormalities. He was recommended for coronary computed tomography angiography (CCTA). The maximum intensity projection image of CCTA showed that the great cardiac vein draining into the left atrium, the rest of the cardiac veins and coronary vein sinus were draining into the right atrium normally. Volume-rendered image of coronary CT angiography showed that the GCV originated in the upper third of the anterior interventricular sulcus and drained directly into the left atrium.

Abnormalities in drainage of the GCV are interesting due to its rarity and likely to be underreported. Only a few cases have been reported that the aberrant drainage of the GCV, with draining into the anterior cardiac veins, the left internal thoracic vein, the superior vena cava, the right atrium, and the LA. The abnormality of GCV is an often neglected aspect of CCTA imaging, it can be better displayed in the venous phase of coronary catheter angiography. The awareness of which may be critically important for procedures that require venous access such as coronary surgery requiring retrograde cardioplegia, surgical ablation of aberrant conducting pathways, pacemaker insertion, and valves surgery.

CCTA has important diagnostic imaging value in abnormalities of the origin, course and termination of the great cardiac veins, the awareness of which may be critically important for procedures that require venous access.