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[Morphological study of cardiac veins that drain into the coronary sinus, with special reference to the coronary
1Department of Anatomy, Nippon Medical School, Tokyo, Japan.
Insights
This study on cardiac veins found significant differences in left marginal vein angles between coronary artery patterns. Poor right ventricular perfusion may occur during surgery with well-developed anterior cardiac veins.
Area of Science:
- Cardiovascular Anatomy
- Cardiac Vein Morphology
- Coronary Artery Anatomy
Context:
- Understanding the venous drainage of the heart is crucial for cardiac surgery.
- Coronary artery dominance patterns influence cardiac vein morphology.
- Retrograde coronary sinus perfusion (RCSP) is a surgical technique with potential perfusion limitations.
Purpose:
- To investigate the morphological variations of cardiac veins draining into the coronary sinus.
- To correlate these variations with coronary artery dominance patterns (Barnes' classification).
- To assess the implications for right ventricular perfusion during cardiac surgery.
Summary:
- Examined 31 human hearts, focusing on the great cardiac vein, left marginal vein (LMV), left posterior ventricular vein, middle cardiac vein, small cardiac vein, anterior cardiac veins (ACVs), and coronary sinus.
- Found statistically significant differences in LMV influx angles between Barnes type I and type II coronary artery patterns.
- Observed a significant negative correlation between the number of ACVs and the small cardiac vein index.
Impact:
- Reveals anatomical variations in cardiac veins related to coronary artery patterns.
- Highlights potential challenges in achieving effective right ventricular perfusion during RCSP, particularly when ACVs are well-developed.
- Informs surgical strategies to optimize perfusion and patient outcomes in cardiac procedures.
Abstract:
The morphology of the cardiac veins that drain into the coronary sinus was studied in 31 human hearts, with special reference to the coronary artery dominant pattern (Barnes' classification). The results were as follows: 1. Great cardiac vein (GCV) The average GCV index of Barnes type I (BI) did not differ significantly from that of Barnes type II (BII). 2. Left marginal vein (LMV) (1) The LMVs were divided into two types, according to the angle made by the LMV and the truncal vein: rect (18 cases, 58%) and acute (11 cases, 38%) angular influx type. (2) The average LMV angle of BI (n = 9, mean +/- SD 77.0 +/- 23.2) was greater than that of BII (n = 19, mean +/- SD 48.1 +/- 34.3) and the difference was statistically significant (p < 0.05). (3) The average LMV index of BI did not differ significantly from that of BII. 3. Left posterior ventricular vein (LPVV) (1) The average LPVV influx angle of BI did not differ significantly from that of BII. (2) The average LPVV index of BI did not differ significantly from that of BII. 4. Middle cardiac vein (MCV) The average MCV index of BI did not differ significantly from that of BII. 5. Small cardiac vein (SCV) The average SCV index of BI did not differ significantly from that of BII. 6. Anterior cardiac veins (ACVs) The number of ACVs correlated with the SCV index, and the correlation was statistically significant (n = 31, r = -0.416, p < 0.02). 7. Coronary sinus (CS) The average CS index of BI did not differ significantly from that of BII. The right ventricular wall may not be perfused effectively during open heart surgery when retrograde coronary sinus perfusion (RCSP) is used. The present study demonstrated that this method can produce poor right ventricular perfusion in cases when the ACVs developed well.