Smallest cardiac veins

Smallest cardiac veins
Details
Identifiers
Latin Venae cardiacae minimae,
venae cordis minimae
TA A12.3.01.013
FMA 71568

Anatomical terminology

The smallest cardiac veins (or Thebesian veins)[1][2] are minute valveless veins in the walls of all four heart chambers.[3] The veins are sometimes accurately referred to as vessels, but they are frequently confused[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] with a distinct set of artery connections[20][21][22] eponymously referred to as the "vessels of Wearn".[23] The Thebesian veins are reportedly most abundant in the right atrium and least in the left ventricle. They drain the myocardium[24] and run a perpendicular course to the endocardial surface, directly connecting the right atrium to the medium sized, and larger coronary veins.[25]Thebesian veins have been successfully identified by following the route of contrast flow - during catheterization procedures - from the subendocardium, through the thebesian veins, into larger veins, and into the coronary sinus.[26] The coronary sinus empties into the right atrium.


The Thebesian venous network is considered an alternative venous drainage of the myocardium. Thebesian veins draining into the left heart, along with deoxygenated blood originating from the bronchial arteries draining into the pulmonary veins, contribute to normal physiologic shunting of blood. As a consequence of the input of these vessels, blood in the left heart is less oxygenated than the blood found at the pulmonary capillary beds, albeit to a very small degree.

The openings of smallest cardiac veins are located in the endocardium. Here the smallest cardiac veins return blood into the heart chambers from the capillary bed in the muscular cardiac wall, enabling a form of collateral circulation unique to the heart. Not every endocardial opening connects to the Thebesian veins as some connect to the vessels of Wearn, which are arteries. Therefore, the endocardial opening must be traced to a vein before it is definitely called an opening of the smallest cardiac veins.

The Thebesian veins are named after the German anatomist Adam Christian Thebesius, who described them in a 1708 treatise called Disputatio medica inauguralis de circulo sanguinis in corde.[27][28]

References

  1. ↑ Judkins, C; Yamen, E (February 2013). "Inadvertent thebesian vein cannulation during radial access ventriculography.". JACC. Cardiovascular interventions 6 (2): e9–e10. PMID 23428022.
  2. ↑ Singhal, S; Khoury, S (14 August 2008). "Images in clinical medicine. Imaging of thebesian venous system.". The New England journal of medicine 359 (7): e8. PMID 18703466.
  3. ↑ BLAKE, HA; MANION, WC; MATTINGLY, TW; BAROLDI, G (December 1964). "CORONARY ARTERY ANOMALIES.". Circulation 30: 927–40. PMID 14246341.
  4. ↑ . PMID 21660925. Missing or empty |title= (help)
  5. ↑ Jung, Y; Kim, HJ; Yoon, CH (October 2012). "Severe form of persistent thebesian veins presenting as ischemic heart disease.". Korean circulation journal 42 (10): 714–7. PMID 23170102.
  6. ↑ Alam, R; Skehan, J; Gunarathne, A (27 March 2015). "A significant 'coronary steal' by thebesian veins, a rare congenital coronary defect masquerading as acute coronary syndrome.". BMJ case reports 2015. PMID 25819822.
  7. ↑ Adjedj, J; Meert, V; Vanderheyden, M; Van Mieghem, C (20 April 2016). "Direct coronary drainage to the left ventricle via Thebesian veins: series report with histologic and cardiac CT analysis.". EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 11 (13): 1564. PMID 27107318.
  8. ↑ MOIR, T. W.; ECKSTEIN, R. W.; DRISCOL, T. E. (1 February 1963). "Thebesian Drainage of the Septal Artery". Circulation Research 12 (2): 212–219. doi:10.1161/01.RES.12.2.212.
  9. ↑ Echeverri, D; Cabrales, J; Jimenez, A (February 2013). "Myocardial venous drainage: from anatomy to clinical use.". The Journal of invasive cardiology 25 (2): 98–105. PMID 23388231.
  10. ↑ Ansari, A (2001). "Anatomy and clinical significance of ventricular Thebesian veins.". Clinical anatomy (New York, N.Y.) 14 (2): 102–10. PMID 11241745.
  11. ↑ Diab, OA; Amer, MS; Salah El-Din, RA (5 February 2016). "Effect of experimental coronary sinus ligation on myocardial structure and function in the presence or absence of structural heart disease: an insight for the interventional electrophysiologist.". Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. PMID 26850747.
  12. ↑ Khoueiry, Georges; Baydoun, Hassan; Abi →Rafeh, Nidal; McCord, Donald; Olkovky, Yefim (March 2014). "Persistent Thebesian Vessels Involving the Right and Left Ventricles Leading to Coronary Steal Phenomena and Ischemia". Congenital Heart Disease 9 (2): E61–E65. doi:10.1111/chd.12077.
  13. ↑ Park, KW; Kim, YJ; Kim, HS (October 2007). "A prominent coronary Thebesian system.". European heart journal 28 (20): 2448. PMID 17548340.
  14. ↑ Tsang, JC; Chiu, RC (December 1995). "The phantom of "myocardial sinusoids": a historical reappraisal.". The Annals of thoracic surgery 60 (6): 1831–5. PMID 8787502.
  15. ↑ Yildiz, Bekir Serhat; Bilgin, Murat; Alihanoglu, Yusuf Izzettin; Evrengul, Harun (July 2013). "A case of multiple coronary microfistulas to the left ventricle and apical myocardial hypertrophy coexisting with stable angina". Journal of the Saudi Heart Association 25 (3): 209–211. doi:10.1016/j.jsha.2013.02.002.
  16. ↑ Mizuguchi, Y; Takahashi, A; Yamada, T; Taniguchi, N; Nakajima, S; Hata, T (12 October 2013). "Unexpectedly abundant coronary Thebesian system: possible cause of chest pain and abnormal electrocardiogram results.". International journal of cardiology 168 (5): 4909–12. PMID 23911272.
  17. ↑ Akhtar, S; Lluberes, V; Allen, K; Rajaii-Khorasani, A; Wasnick, JD (February 2001). "Unexpected, transesophageal echocardiography-detected left ventricular microbubbles during off-pump coronary artery bypass graft surgery.". Journal of cardiothoracic and vascular anesthesia 15 (1): 131–3. PMID 11254857.
  18. ↑ Loukas, M; Germain, AS; Gabriel, A; John, A; Tubbs, RS; Spicer, D (Published Online: 10 February 2014). "Coronary artery fistula: a review.". Cardiovascular Pathology 24 (3): 141–8. PMID 25965423. Check date values in: |date= (help)
  19. ↑ Cha, SD; Singer, E; Maranhao, V; Goldberg, H (February 1978). "Silent coronary artery-left ventricular fistula: a disorder of the thebesian system?". Angiology 29 (2): 169–73. PMID 646180.
  20. ↑ Grollman JH, Jr (March 1998). "Re: three major coronary artery-to-left ventricular shunts.". Cardiovascular and interventional radiology 21 (2): 183. PMID 9502691.
  21. ↑ Wearn, Joseph (October 1941). "Morphological and functional alterations of the coronary circulation". Bull NY Acad Med. 17 (10): 754–777.
  22. ↑ Wearn, Joseph T.; Mettier, Stacy R.; Klumpp, Theodore G.; Zschiesche, Louise J. (December 1933). "The nature of the vascular communications between the coronary arteries and the chambers of the heart". American Heart Journal 9 (2): 143–164. doi:10.1016/S0002-8703(33)90711-5.
  23. ↑ Hussain, M; Roberts, EB (2 July 2015). "Association of coronary to left ventricular microfistulae (vessels of Wearn) with atrial septal defect in an adult without cyanotic heart disease.". BMJ case reports 2015. PMID 26139649.
  24. ↑ A. M. R. Agur; Arthur F. Dalley (2009). Grant's atlas of anatomy. Lippincott Williams & Wilkins. pp. 53–. ISBN 978-0-7817-7055-2. Retrieved 31 October 2010.
  25. ↑ Pratt, FH (1898). "The nutrition of the heart through the vessels of Thebesius and the coronary veins" (PDF). Am J Physiol. 1: 86–103.
  26. ↑ Judkins, C; Yamen, E (February 2013). "Inadvertent thebesian vein cannulation during radial access ventriculography.". JACC. Cardiovascular interventions 6 (2): e9–e10. PMID 23428022.
  27. ↑ synd/4013 at Who Named It?
  28. ↑ A. C. Thebesius. Disputatio medica inauguralis de circulo sanguinis in corde. Doctoral dissertation, Leiden, 1708.

External links

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