The aim of this work is to determine morphological and topographical aspects
of the great cardiac vein, especially its relation to the branches of the left coronary artery. The examination of the cardiac veins was carried out on 36 specimens of hearts of both sexes aged between 12 and 70 and without any known history of change in cardiac pathology. The techniques applied by us were anatomical dissection and retrograde injection of the coronary vessels with Polimal 100, Polimal 150 and Durakryl resin. We examined the topography and morphology of the great cardiac vein and the mutual correlation between the great cardiac vein and the branches of the left coronary artery

Czerwiński, F.

Kaczmarek, M.

English

Via Medica Journals

Folia Morphol. Vol. 66, No. 3, pp. 190–193Copyright © 2007 Via MedicaISSN 0015–5659www.fm.viamedica.plO R I G I N A L   A R T I C L E190Address for correspondence: M. Kaczmarek, Department of Human Anatomy, Pomeranian Medical University of Szczecin, PowstańcówWielkopolskich 72, 70–111 Szczecin, Poland, tel: +48 91 466 14 80, e-mail: majulka@poczta.fmAssessment of the course of the great cardiacvein in a selected number of human heartsM. Kaczmarek, F. CzerwińskiDepartment of Human Anatomy, Pomeranian Medical University of Szczecin, Poland[Received 15 January 2007; Revised 8 June 2007; Accepted 15 June 2007]The aim of this work is to determine morphological and topographical aspectsof the great cardiac vein, especially its relation to the branches of the left coro-nary artery. The examination of the cardiac veins was carried out on 36 speci-mens of hearts of both sexes aged between 12 and 70 and without any knownhistory of change in cardiac pathology. The techniques applied by us were an-atomical dissection and retrograde injection of the coronary vessels with Polimal 100,Polimal 150 and Durakryl resin. We examined the topography and morphologyof the great cardiac vein and the mutual correlation between the great cardiacvein and the branches of the left coronary artery.Key words: human heart, cardiac veinsINTRODUCTIONThe great cardiac vein (GCV) is the longest veinof the heart and supplies the greatest inflow of thecoronary sinus. Normally GCV originates in the ster-num-rib surface near the apex of the heart, fromwhere it runs through the interventricular sulcus tothe base of the heart [3]. This first part, which issituated in the interventricular sulcus and which ac-companies the anterior interventricular branch of theleft coronary artery, is called the anterosuperior in-terventricular vein [4] or the anterior interventricu-lar vein [13]. Circling the pulmonary surface of theheart, GCV runs in the coronary sulcus, passing intothe left end of the coronary sinus on the phrenicsurface of the heart. Given the present developmentof the diagnostic methods in cardiology, it is essen-tial to carry out a detailed analysis of the course ofGCV as well as of the correlation between its courseand branches of the left coronary artery, as this maybe helpful in the surgical treatment of these vessels.The arteriovenous connections in the human heartshould, moreover, not be underestimated, especial-ly in the light of research strongly reaffirming theimportance of the diagnosis and therapy of ischaemicmyocardial lesions [7, 16].The aim of this work is to examine the variabilityof the course and the morphology of GCV as well ascorrelations between the great cardiac vein and theanterior interventricular and circumflex branches ofthe left coronary artery. These relationships resultfrom the arteriovenous Brocq and Mouchet trian-gle, which has been classified by Pejkovic andBogdanovic [15] as open or closed.Various works on the different courses of singleveins in the human heart can be found in the literature[2, 5, 9, 10]. It has been observed that variability in thecourse of GCV occurs more often than is the case withthe middle cardiac vein [8]. In the research carried outby von Luedinghausen [9] it was reported that the greatcardiac vein can also empty into the right atrium,whereas Yener et al. [17] reported a case in which GCVdrained directly into the internal thoracic vein.MATERIAL AND METHODSExamination was made of 36 preparations ofhuman hearts from cadavers of both sexes aged191M. Kaczmarek, F. Czerwiński, Assessment of the course of the great cardiac veinbetween 12 and 70 years and without any knownhistory of change in cardiac pathology. The materialoriginated from the Department of Human Anatomyof the Pomeranian Medical University of Szczecin.Both the veins and the coronary arteries of theexamined hearts were filled with the epoxy resinPolimal 100 and Polimal 150 and with the resin Du-rakryl. The application of the resin allowed the veinsas well as the arteries to be visualised exactly.The epoxy resin was dissolved in the solvent andthe hardening substance and the dye were added.Once the required level of consistency had beenachieved, the resin was administered to the exam-ined hearts. A blue pigment was added to the resinin order to distinguish the veins from arteries. Next,the preparation was left dipped in glycerine for24 hours, which allowed it to retain the natural shapeof the human hearts. During fixation the hearts werehung with their great vessels on the stands in sucha manner that they could not touch any surface orbecome deformed. As a result, casts showing theexact course of the arterial and the venous vesselscould be obtained. Once the resin had become hard,the heart preparations were etched into 40% hydro-chloric acid, which allowed further precise casts ofthe hearts and all their vessels to be obtained.The veins were measured with an electronic ver-nier calliper gauge, the lengths of the veins witha planimeter and the angles of departure with a go-niometer.RESULTSFrom the cases examined it was found that 41%of GCV originated in the lower third of the anteriorinterventricular sulcus, while 80% came into beingas a result of a connection between two veins and20% as a connection between three veins.A total of 17% of veins came both into middlethird and the superior third of the anterior interven-tricular sulcus. In 67% of these cases it arose fromtwo veins and in 33% from three veins. When all theexamined hearts were taken into account, GCV arosefrom the connection of two veins in 74% cases andfrom three veins in 26%.In 9 cases (25%) GCV united in the apex of theheart with the middle cardiac vein, forming a largevenous arc (Fig. 1). These veins, emptying to the cor-onary sulcus, formed a venous ring round the leftventricle.The maximum length of GCV, measuring fromthe beginning of its longest branch and finishing inthe lower left part of the coronary sulcus, amountedto 25.3 cm, the minimum length to 12.4 cm and theaverage length to 17.7 cm.The GCV in all the given cases emptied to the cor-onary sulcus at an angle of 180°. The diameter of theoutlet of GCV to the coronary sulcus fluctuated be-tween 3 and 8.5 mms (average amounting 5.8 mms).In 39% of cases GCV ran near the coronary sul-cus over the diagonal and circumflex branches ofthe left coronary artery. Similarly, in 39% GCV passedover the circumflex and simultaneously under thediagonal branches. In 8% cases it ran over the diag-onal branch and under the circumflex. In 14% casesGCV ran under the diagonal and circumflex branch-es (Fig. 2).The great cardiac vein, along with the circumflexand the anterior interventricular branches of the leftcoronary artery, form the arteriovenous triangle de-scribed as the Brocq and Mouchet triangle, the baseof which is created by GCV (81%). Despite the factFigure 1. The apex of the heart. The large venous arc is formed bythe great cardiac vein (GCV) and the middle cardiac vein (MCV).Figure 2. The great cardiac vein (GCV) runs under the diagonal(DB) and circumflex branches (CB) of the left coronary artery.192Folia Morphol., 2007, Vol. 66, No. 3that it is formed by the three vessels mentionedabove, it is sometimes divided into smaller trian-gles by the branches of the left coronary artery, thelargest of which is the diagonal [6]. According toPejkovic and Bogdanovic [15], the triangle can beclosed, open completely or open at its right or leftend, depending on the position of the vessels whichform it. Its topography and morphology proved tohave significant variability. In 73% of the cases ex-amined the triangle was open at the right lower end,that is to say GCV ran in the anterior interventricularsulcus on the left of the anterior interventricularbranch, crossing the circumflex branch (Fig. 3).In 7% of the cases examined the triangle was opencompletely, GCV not crossing any of the branchesof the left coronary artery. In 3% of the cases GCVonly crossed the anterior interventricular branch, cre-ating an open triangle at the left end. In 5 of thecases examined (17%) GCV was situated to the rightof the anterior interventricular branch, crossing bothbranches of the left coronary artery and forming inthis way a closed triangle.In 7 cases (19%) the anterior interventricular vein,running in the interventricular sulcus upward to theplace of division of the left coronary artery, createdan acute venous angle and became the great cardiacvein.In the examined cases we did not observe thepresence of GCV in the myocardial bridges. The in-tramuscular course of this vein could indicate dys-rhythmia [9, 14, 15].In all 36 cases examined the anterior interven-tricular vein, following its own course, accompaniedthe anterior interventricular branch of the left coro-nary artery, situated in most cases (83%) on the leftside parallel to the artery. The maximum distancebetween the vein and the artery amounted to 9.5 mm,at a minimum distance of 2 mm and with an aver-age distance of 5.3 mm.DISCUSSIONThe correlation between GCV and the branches ofthe left coronary artery show a very high degree ofvariability in the research carried out [9, 11, 12, 15].Where the anterior interventricular vein was in the lowertwo thirds of the interventricular sulcus, it was, in themajority of cases, situated parallel to and on the leftside of the anterior interventricular branch of the leftcoronary artery. This result is in accordance with theresearch carried out by McAlpine [11]. According toPejkovic and Bogdanovic [15], it is situated more oftenon the right of the anterior interventricular branch.In our cases the maximum distance between theanterior interventricular vein and the anterior inter-ventricular branch of the left coronary artery amount-ed to 9.5 mm, with a minimum of 2 mm (average5.3 mm), which corresponds to the data of otherauthors [14].Where the anterior interventricular vein runs in theanterior interventricular sulcus and arrives at the areaof division of the left coronary artery variations in itsposition are revealed. In the material examined by usGCV was situated superficially to the diagonal andthe circumflex branches in 39%. In the same percent-age of cases it ran superficially to the circumflex branchand deeply to the diagonal branch. The superficialposition to the circumflex and diagonal branches isconsistent with the data of other authors [9, 15].However, a course of GCV deeper than the diagonalbranch and superficial to the circumflex branch wasfound, according to von Luedinghausen [9], in 9% ofcases. In 8%, a lower percentage than found by vonLuedinghausen (21%), it was ascertained that theposition of GCV was superficial to the diagonal branchand deep in the relation to the circumflex branch.Otherwise, the superficial position of both branchesFigure 3. The Brocq and Mouchet triangle is open in the right low-er end. The great cardiac vein (GCV) runs at the left side from theanterior interventricular branch (AIB) of the left coronary arterycrossing the circumflex branch (CB) of the left coronary artery.193M. Kaczmarek, F. Czerwiński, Assessment of the course of the great cardiac veinof the left coronary artery in relation to GCV (14%) isclose to the results given by other authors [9].The arteriovenous triangle formed by branchesof the left coronary artery and GCV may, in accor-dance with the criteria given by Pejkovic andBogdanovic [15], be closed, or open completely, oropen only on one side. We were able to establishthe presence of the triangle in 29 out of 36 of theexamined hearts (81%). In the research by Pejkovicand Bogdanovic [15] GCV ran most often on the rightside of the anterior interventricular branch of theleft coronary artery, forming a closed triangle, where-as in our research the triangle most often (73%) ap-peared open in the right end, which is supported bythe research carried out by Ortale (64%). Regardingthe closed triangle, we were able to observe this inonly 5 cases (17%). In only 1 case (3%) did we ascer-tain that GCV following its own course covered theanterior interventricular branch without crossing thecircumflex branch at the same time, as confirmedalso by Ortale et al. [14].The anterior interventricular vein, when runningon the left of the anterior interventricular branch ofthe left coronary artery, as it did in 7 cases (19%),arriving at the area of partition of the left coronaryartery, bends and forms the acute venous angle andcontinues to run in the coronary sulcus. When theposition of GCV is deeper than the arteries this canresult in pressure [15]. In the research by Pejkovicand Bogdanovic [15] the Brocq and Mouchet trian-gle was present in 98% of cases and the venous an-gle only in 2% cases, which may be supported bythe work of other researchers [11, 12]. The resultsreported by Ortale et al. [14] are similar to ours, withthe presence of the Brocq and Mouchet triangle de-tected in 89% of cases and the venous angle in 17%of 37 examined human hearts.In all the cases examined GCV emptied to thecoronary sulcus. The maximum diameter of the out-let GCV amounted to 8.5 mm and the minimum to3 mm, with an average of 5.8 mm. This is consistentwith the results obtained by other authors [1, 6, 15].REFERENCES1. Adachi B (1933) Das Venensystem der Japaner. Kyoto,pp. 40–612. Bahru C, Schippel K (1990) Abnormal drainage of themiddle cardiac vein (V. cordis media). Anat Anz Jena,171: 218–220.3. Bochenek A, Reicher M (1960) Anatomia człowieka.Vol. 5. 4rd ed. PZWL, Warszawa.4. Buchanan AM (1921) Manual of anatomy. Bailliere,Tindal and Cox, London.5. Duda B, Grzybiak M (1999) Variability of posterior veinsof the left ventricle in the adult human heart. FoliaMorphol, 58: 31–36.6. Gray’s anatomy (1980) Churchill Livingstone, London.7. Horneffer PJ, Gott VL, Gardner TJ (1986) Retrogradecoronary sinus perfusion prevents infarct extension dur-ing intraoperative global ischemic arrest. Ann ThoracSurg, 42: 139–142.8. Kawashima T, Sato K, Sato F, Sasaki H (2003) An ana-tomical study of the human cardiac veins with specialreference to the drainage of the great cardiac vein.Ann Anat, 185: 535–542.9. von Luedinghausen M (1987) Clinical anatomy of car-diac veins, Vv. Cardiacae. Surg Radiol Anat, 9: 159–168.10. Mantini E, Grongin CM, Lillehei CW, Edwards JE (1960)Congenital anomalies involving the coronary sinus.Circulation, 33: 317–327.11. McAlpine WA (1975) Heart and coronary arteries.Springer, Berlin, pp 188–19612. Nguyen H, Monod-Nguyen, Vallee B, Monod JE (1982)Anatomical relations of the atrioventricular junction.Anat Clin, 3: 339–355.13. Nomina anatomia (1989) 6th ed. Churchill Livingstone,London.14. Ortale JR, Gabriel EA, Iost C, Marquez CQ (2001) Theanatomy of the coronary sinus and its tributaries. SurgRadiol Anat, 23: 15–21.15. Pejkovic B, Bogdanovic D (1992) The great cardiac vein.Surg Radiol Anat, 14: 23–28.16. Solorzano J, Taitelbaum, Chiu RCJ (1978) Retrogradecoronary sinus perfusion for myocardial protectionduring cardiopulmonary bypass. Ann Thorac Surg, 25:201–208.17. Yener N, Sueruecue HS, Dogan R, Aludur MM (2001)A case with dextrocardia, ventricular septal defect,persistent left superior vena cava and drainage of thegreat cardiac vein into the left internal thoracic vein.Surg Radiol Anat, 23: 205–206.

Assessment of the course of the great cardiac vein in a selected number of human hearts

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Assessment of the course of the great cardiac vein in a selected number of human hearts

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