The Venous Drainage of the Myocardium in the Human Heart
Michael von Lüdinghausen, Nobuko Ohmachi and Shoji Chiba Introduction
The coronary sinus (cs) is the anatomically appropriate location for the placement of a balloon catheter for retrograde perfusion or revascularization, in particular of the vessels of the left ventricular myocardium, in a case of severe stenosing coronary heart disease and jeopardized myocardium. However, the results of invasive cardiological procedures via the cs are not satisfactory and are even inadequate in 1-5% of cases.14'15 These cases reinforce the need not only for biochemical and physiological but also for anatomical reexamination. It was naturally impossible to carry out such examinations on patients who had undergone treatment; therefore we undertook a study of a large number of hearts from the dissection room.
The major venous drainage system of the human heart consists of four intercommunicating parts which generally open into the right atrium.3 Very frequently the terminal veins of each drainage system are intramurally widened to form spaces, collectors, or sinuses, before emptying into the right atrium.5 Among these collectors the cs, which is the main structure in the left posterior portion of the coronary sulcus, is of functional predominance. It collects the major cardiac veins: the great vein, the left marginal vein, the posterior vein of the left ventricle and the middle and small cardiac veins. In addition there are the oblique and the posterior veins of the left atrium, both of which empty into the cs.2,9,21
These major cardiac veins carry out, almost exclusively, the drainage of two-thirds of the left ventricular myocardium; they do not, however, drain the superior part of the interventricular septum, nor the myocardium of the right atrium and ventricle or the myocardium of the roof of the left atrium. In view of the fact that individual microanatomical conditions have to be taken into consideration when a catheter-tip is inserted into the coronary sinus,14,15,17 it is the purpose of the present Chapter to clarify the anatomical situation of the cs and its tributaries so as to minimize the instances of failure of the technical procedure, damage, and hemorrhage of the endocardial-myocardial-endothelial complex.3,5,12
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