Morphological study of cardiac veins that drain into the coronary sinus, with special reference to the coronary artery dominant pattern Department Tak

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1 Morphological study of cardiac veins that drain into the coronary sinus, with special reference to the coronary artery dominant pattern Department Takao Fukushima of Anatomy, Nippon Medical School 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 infux 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 Correspondence to Takao Fukushima, Department of Anatomy, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113, Japan

2 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. Key words: retrograde coronary sinus perfusion, human cardiac veins, coronary artery dominant pattern Fig. 1 Definition of the influx angle

3 Fig. 2 Diaphragmatic aspect of the ventricles. Five dominant types of the coronary artery, cited by Nobuyoshi as Barnes' classification. L and R: left and right coronary artery. Fig. 3 Histogram of the great cardiac vein (GCV) index. A GCV index is a relative value of a length between the apex and the origin of the great cardiac vein to that of the anterior interventricular sulcus.

4 Fig. 4 Anterior aspect of the heart. Ao: aorta, LA: left atrium, LCA: left coronary artery, pt: pulmonary trunc, PV: pulmonary vein Fig. 5 In the anterior interventricular sulcus the great cardiac vein (GCV) crossed the anterior interventricular branch of the left coronary artery (AIB) in 20 cases or ran parallel in 11 cases. In detail: GCV crossed over AIB in 10 cases, under in 10 cases. GCV (black), Left coronary artery (gray)

5 Fig. 6 (486) In the anterior lateral (gray) wall of the left ventricle branch of existed coronary in 29 cases. diac vein (black) under the crossed Fig. 7 the artery The great car- over it in 9 cases, in 20 cases. で 交 叉 し,20例(65%)で 大 心臓静脈が回旋枝 の 前 面 を 走 行 し,11例(35%)で 回 旋 枝 が 前 面 を走 行 し て い た(Fig.7).Fig.8は 以上の結果 をグラ フ と し た も の で あ る. 4)冠 indexは vein,lmv) て大 心 臓 静 脈 に開 口す る静 脈 と した. 中29例(94%)に 存 在 し, 叉,ま た は並 走 す る もの が み られ た. (1)左 辺 縁 静 脈 の 開 口部 III型(n=1)で0.368,BIV型(n=2)で0.187± とBII型 marginal 左 辺 縁 静 脈 は左 心 室 よ り起 始 し心 左 縁 を上 行 し 後 述 の よ う に心 左 縁 を走 行 す る左 冠 状 動 脈 と交 deviation),bii型(n=19)で0.248±0.139,b あ っ た.BI型 3.左 辺 縁 静 脈(left 左 辺 縁 静 脈 は31例 状 動 脈 の 優 位 型 に 対 す るGCV BI型(n=9)で0.268±0.076(mean±standard 0.042で In the coronary sulcus the great cardiac vein (black) crossed over the circumflex branch of the left coronary artery (gray) in 20 cases, under in 11 cases 後 室 間 溝 上 端 か ら前 室 間 溝 上 端 まで の 右 の冠 状 に有 意 差 は み られ な い(Fig.9). 溝 の 長 さ を1.0と し左 辺 縁 静 脈 の 開 口部 を後 室 間 溝 上 端 か ら の 長 さ で 表 わ し た.こ indexと Fig. 8 Crossing of the great cardiac れ をLMV した.そ の平 均(mean±standard vein and the left coronary artery devia-

6 Fig. 9 Changes in mean great cardiac vein (GCV) index for every dominant type of the coronary artery Fig. 10 Histogram of left marginal vein (LMV) index. An LMV index is a relative value of a length between the opening of the left marginal vein and the crux to that of the left coronary sulcus.

7 Fig. 11 Scattergram of left coronary vein (LMV) index and values of influx angle Fig. 12 Lateral aspect of the heart. The left marginal vein (LMV) drained into the great cardiac vein (GCV) right angularly in 18 cases, acute angularly in 11 cases. GCV: great cardiac vein, LMV: left marginal vein

8 Fig. 13 Changes in mean left marginal vein (LMV) influx angle for every dominant type of the coronary artery. An LMV influx angle is that of the LMV and the great cardiac vein. Fig. 14 Changes in mean left marginal vein (LMV) index for every dominant type of the coronary artery

9 Fig. 15 Scattergram of left posterior ventricular vein (LPVV) indexes and LPVV influx angles. An LPVV influx angle is that of the LPVV and coronary sinus. An LPVV index is a relative value of a length between the right side of the LPVV and the left side of the middle cardiac vein to that of the left coronary sulcus. Fig. 16 Diaphragmatic aspect of the heart. The left posterior ventricular vein drained into the coronary sinus right angularly in 17 cases, acute angularly in 9 cases and confluently with the middle cardiac vein in 5 cases. CS: coronary sinus, LPVV: left posterior ventricular vein, MCV: middle cardiac vein

10 Table 1 Relation of the 5 dominant types of the coronary artery to the 3 types of the left posterior ventriclar vein Fig. 17 Changes in meas left posterior ventricular vein (LPVV) angle for every dominant type of the coronary artery

11 Fig. 18 Changes in mean left posterior ventricular vein (LPVV) index for every dominant type of the coronary artery Fig. 19 Histogram of middle cardiac vein (MCV) index. An MCV index is a relative value of a length between the apex and the beginning of the MCV. A positive value is for a relative length to that of the anterior interventricular sulcus and a negative the posterior interventricular sulcus. LV: left ventricle, RV: right ventricle

12 Fig. 20 Changes in mean middle cardiac vein (MCV) index for every dominant type of the coronary artery Fig. 21 Diaphragmatic aspect of the heart. The small cardiac vein originated in the right ventricle in 16 cases and in the right atrium in 7 cases. It was missing in 8 cases. CS: coronary sinus, MCV: middle cardic vein, RCA: right coronary artery (gray), SCV: small cardiac vein (black)

13 Table 2 Relation of the 5 dominant types of the coronary artery to the 2 beginning types of the small cardiac vein Table 3 Number of cases for every number of the anterior cardiac veins Fig. 22 Changes in meas small cardiac vein (SCV) index for every dominant type of the coronary artery. A SCV index is a relative value of a length of the SCV to that of the right coronary sulcus. SCV: small cardiac vein

14 (495) Table Fig. 23 View of the cardiac of both atria. rior cardiac angles around The veins from the the tricupsid aorta, MV: mitral trunc, TV: bases after openings were tricupsid of the 5 types to the cardiac veins number of the coronary of the anterior removal by the 9.冠 commisure valve as above. vauve, Relation artery 83 - of the ante- measured anterior 4 - 左 心 房 斜 静 脈(oblique Ao: pt: pulmonary 状 静 脈 洞(coronary OV)開 valve sinus,cs) vein of the left atrium, 口部 か ら冠状 静 脈 洞 口左 縁 まで を 冠状 静 脈 洞 と し た.左 心 房 斜 静 脈 が 不 明 で あ る も の4例 は 除 外 し た. 8.左 心 房 斜 静 脈(oblique vein of the left (1)冠 atrium,ov) 状 静 脈 洞 の長 さ 冠 状 静 脈 洞 の 長 さ は27例 左 心 房 背 面 で 左 肺 静 脈 開 口部 付 近 よ り起 始 し, 10.15mm(mean±standard 右 下 方 に進 ん で 大 心 臓 静 脈 と冠 状 静 脈 洞 の移 行 部 た.左 に開 口 す る もの を左 心 房 斜 静 脈 と した.左 心房 斜 は0.375±0.110で 静 脈 は27例(87%)に 観 察 さ れ た. Fig. 24 Histogram of anterior cardiac 冠 状 溝 の 長 さ を1.0と で 計 測 し35.52± deviation)で し た 場 合(CS あっ index) あ っ た. (2)冠 状 静 脈 洞 の 長 さ と冠 状 動 脈 優 位 型 の 関 係 CS indexはbi型(n=9)で0.394± vein (ACV) influx angle

15 Fig. 25 Regression plot for the number of the anterior cardiac veins (ACVs) and small cardiac vein (SVC) index Fig. 26 Changes in mean coronary sinus (CS) index for every dominant type of the coronary artery. A CS index is a relative value of a length between the opening of the left atrial oblique vein and the right margin of the coronary sinus ostium to that of the left coronary sulcus.

16 Table 5 Beginning of the great cardiac vein in the anterior interventricular sulcus Table 6 Literal review in relation of GCV and the branch of LCA

17

18 Table 7 Length of the coronary sinus 1) Lillehei, C.W., Dewall, R.A., Gott, V.L., and Varco, R.L.: The direct vision correction of calcific aortic stenosis by means of a pump-oxygenator and retrograde coronary sinusperfusion. Dis. Chest, 30, , ) Buckberg, G.D.: Anterograde/retrograde blood cardioplegia to ensure cardioplegic distribution; Operative techniques and objectives. J. Cardiac Surg., 4, , 1989.

19 , ) Camped, F., Gramiak, R., Watson, J.S., Ramsey, G. H., and Weinberg, S.: Visualisation of the coro- sinus in cineangiography. Circulation, 12, nary , ) Shiki, K., Masuda, M., Yonenaga, K., Asou, T., and 15) Goffredo, G., Di Giorgi, G.S., Coskun, O., and Tokunaga, K.: Myocardial distribusion of retrograde flow through the coronary sinus of the ex- in living man. Circulation, 31, , Palacio, A.: Anatomy of the coronary circulation cised normal canine heart. Ann. Thorac. Surg., 41, 16) Piquand, G.: Recherches sur l'anatomie des vaisseaux sanguins du coeur. Journal de l'anatomie et , de la physiologie, 46, p , Annee, ) Mochizuki, S.: Vv, cordis. In: Adachi, B., Das Venensystem der Japaner. 1. Lieferung. p.41-64, Druckanstalt, Kenkyusha, Tokyo, ) Luedinghausen, M.: Clinical anatomy of cardiac veins, Vv cardicae. Surgical Radiological Anatomy, 9, , ) Pejkovic, B., and Bogdanovic, D.: The great cardiac vein. Surg. Radiol. Anat., 14, 23-28, ) Brocq, P., et Mouchet, A.: Les artere coronaires du coeur. Gazette des hopitaux, 58, , ) Hadziselimovic, H., and Secerov, D.: Superficial anastomosis of the human heart; coronarography and dissection. Acta Anat., 106, , ) Schlesinger, M.J.: Relation of anatomic pattern to pathologic conditions of the coronary arteries. Arch. Pathol., 30, , ) Tori, G.: Radiological visualisation of the coronary sinus and coronary veins. Acta Radiol., 36, 25) Luedinghausen, M., Ohmachi, N., and Boot, C.: Myocardial coverage of the coronary sinus and related veins. Clinical Anatomy, 5, 1-15, 1992.

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