Clinical anatomy of cardiac veins, Vv. cardiacae

New methods of cardiological examination and treatment, such as catheterization and arterialization of the coronary sinus, venous reperfusion and cardioplegia have made necessary an exact account of the distribution pattern and the mode of opening of the cardiac veins. 350 hearts were prepared for examination with macroscopical techniques. There are three systems of the major cardiac veins: tributaries of the coronary sinus, anterior cardiac veins, atrial cardiac veins. Their openings lie in a circle-like arrangement between the ostia of both caval veins and just above the tricuspid valve. In most cases there are variably sized intramural collecting chambers or sinuses just before the opening of all the cardiac veins. These sinuses are interpreted to favour the return of cardiac venous bloodstream from the myocardium to the right atrial cavity. The tributaries of the coronary sinus and of the anterior cardiac veins are very variable. There is for instance only in 36% of cases a small cardiac vein, which belongs to the coronary sinus system. In 64% a small cardiac vein does not exist, but its origin, the right marginal vein, joins the system of anterior cardiac veins. This behaviour diminishes the function of the coronary sinus and increases the importance of the system of anterior cardiac veins. Intramural courses of the great cardiac vein, crossing coronary arteries, ostial valves of cardiac veins, ostial valve of coronary sinus and of inferior vena cava, ostial occlusion of coronary sinus, and aneurysm like excavation of the posterodorsal wall of the right atrium have been described also. These facts and structures may cause morphological hindrances fo catheterization of the right atrium and coronary sinus and for reperfusion of cardiac venous drainage pathways. This report about a large conus vein, which is a great cardiac vein joining anterior cardiac veins and about intramural courses of great cardiac vein as well as semicircular venous sinuses in the wall of the right atrium is the first in the literature.