Microanatomy of the human coronary sinus and its major tributaries

  • M. v. Lüdinghausen
  • C. Schott


There are four separate intercommunicating systems of veins in the human heart: a) the system of the tributaries of the coronary sinus (c.s.); b) the system of the anterior cardiac veins; c) the system of atrial veins, and d) the system of Thebesian veins. The largest system is that of the tributaries of the c.s., which collects all the important cardiac veins — great, left marginal and/or posterior ventricular vein, middle and (in one-third of cases) small cardiac vein — and issues into the c.s. which empties into the right atrium (Figs. 1, 2). These veins drain, almost exclusively, the left ventricular myocardium [7]. This pattern of tributaries of the coronary sinus is called a pentade of large cardiac veins [13, 16], which is described and illustrated in textbooks and most anatomic atlases. Thus the c.s. is inserted between the systematic cardiac veins (except anterior cardiac veins) and the right atrium. Due to the concepts and experiments of Beck [2, 6] the c.s. seems anatomically to be the ideal location for the placement of a catheter for purposes of retrograde perfusion or other cardiological procedures [4, 6]. Retroperfusion techniques of the c.s. or regional cardiac veins are based on the generally assumed pattern in which 95% of the ventricular myocardium is drained by the c.s. tributaries. Such a relatively simple general organization does not however fully conform with reexamination in a large number of heart specimens. In fact, individual coronary venous systems feature a variety of anatomical configurations, demanding selective considerations and clinical adjustment of retrograde coronary venous interventions. In practical cardiology in 10%–20% of cases there is a failure of catheterization of the c.s. and cardiac veins [1], such as local subendocardial and mural hemorrhages, disturbances of the conduction system or even perforation of the atrial wall. On the strength of these experiences it is assumed that quite often the procedure of cannulation of the c.s. and cardiac veins is limited by anatomical variations, irregularities, anomalies, and malformations. A few of these, constituting a wide spectrum of variations will be demonstrated.


Coronary Sinus Terminal Portion Cardiac Vein Great Cardiac Vein Great Vein 
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  1. 1.
    Bairn DS (1988) Percutaneous placement of coronary sinus catheters. 3rd international symposium (June 1988, Cambridge, Massachusetts, USA) on myocardial protection via the coronary sinusGoogle Scholar
  2. 2.
    Beck CS (1948) Revascularization of the heart. Ann Surg 128: 854–864CrossRefGoogle Scholar
  3. 3.
    Beck CS, Stanton E, Batiuchok W, Leiter E (1948) Revascularization of heart by a graft of systemic artery into the coronary sinus. JAMA 137: 436–442CrossRefGoogle Scholar
  4. 4.
    Grossmann W (1985) Cardiac catheterization and angiography. 3rd ed Lea & Febiger, PhiladelphiaGoogle Scholar
  5. 5.
    Hellerstein HK, Orbison JL (1951) Anatomic variations of the orifice of the human coronary sinus. Circulation 3: 514–523PubMedCrossRefGoogle Scholar
  6. 6.
    Hochberg MS, Austen WG (1980) Selective retrograde coronary venous perfusion. Ann Thorac Surg 29: 578–588PubMedCrossRefGoogle Scholar
  7. 7.
    Hood WB (1968) Regional venous drainage of the human heart. Br Heart J 30: 105–109PubMedCrossRefGoogle Scholar
  8. 8.
    James TH, Sherf L, Schlant RC, Silverman ME (1982) Anatomy of the heart. In: Hurst JW (ed) The heart, 5th ed, McGraw-Hill, New YorkGoogle Scholar
  9. 9.
    v. Lüdinghausen M (1987) Clinical anatomy of cardiac veins, Vv. cardiacae. Surg Radiol Anat 9: 159–168CrossRefGoogle Scholar
  10. 10.
    v. Lüdinghausen M, Lechleuthner A (1988) Atresia of the right atrial ostium of the coronary sinus. Acta Anat 131: 81–83CrossRefGoogle Scholar
  11. 11.
    Malhotra VK, Tewari SP, Tewari PS, Agarwa SK (1980) Coronary sinus and its tributaries. Anat Anz (Jena) 148: 331–332Google Scholar
  12. 12.
    Maros TN, Racz L, Plugor S, Maros TG (1983) Contribution to the morphology of the human coronary sinus. Anat Anz (Jena) 154: 133–144Google Scholar
  13. 13.
    Mechanik N (1934) Das Venensystem der Herzwände. Z Anat Entw Gesch 103: 813–843CrossRefGoogle Scholar
  14. 14.
    Potkin BN, Roberts WC (1988) Size of coronary sinus at necropsy in subjects without cardiac disease and in patients with various cardiac conditions. Am J Cardiol 60: 1418–1421CrossRefGoogle Scholar
  15. 15.
    Silver MA, Rowley NE (1988) The functional anatomy of the human coronary sinus. Am Heart J 115: 1080–1084PubMedCrossRefGoogle Scholar
  16. 16.
    Tandler J (1926) Lehrbuch der systematischen Anatomie, 3 Bd. Das Gefäßsystem. Vogel, Leipzig, pp 26–95Google Scholar
  17. 17.
    Tschabitscher M (1984) Anatomy of coronary sinus. In: Mohl W, Wolner E, Glogar D (eds) The coronary sinus. Springer Berlin Heidelberg New York, pp 8–25Google Scholar
  18. 18.
    Tschabitscher M (1986) The so-called “silent zone” of the coronary sinus. In: Mohl W, Faxon D, Wolner E (eds) CSI — A new approach to interventional cardiology. Springer Berlin Heidelberg New York, pp 11–14Google Scholar
  19. 19.
    Yater WM (1929) Variations and anomalies of the venous valves of the right atrium of the human heart. Arch Pathol 7: 418–441Google Scholar

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© Springer-Verlag Berlin Heidelberg 1990

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  • M. v. Lüdinghausen
  • C. Schott

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