Abstract
AimsThe number of cardiovascular procedures using the coronary sinus (CS) as a gateway is constantly increasing. The present study aimed to define specific structures within CS, which could potentially complicate CS cannulation and to develop a new Thebesian valve (TV) classification system.Methods and resultsThe study was performed on 560 consecutive unfixed cadaveric hearts during routine autopsy examination (1–3 days post-mortem). Basic CS dimensions were measured and the presence and dimensions of the TV and the Vieussens valve (VV) were assessed. Thebesian valves were classified according to their morphology into six main types: remnant fold, semilunar, fenestrated, chord, fused strands, and mixed shaped. The median age of hearts was 48 years (range 16–95 years), and 38.9% were female. Thebesian valve was present in 79.5%. The most common TV type was semilunar (54%) followed by fenestrated (8.2%), remnant fold (5.5%), fused strands (4.8%), chord (4.0%), and mixed shaped (3.0%). In 1.1% of hearts, TV totally covered the coronary sinus ostium (CSO). The VV was detected in 67.9%. Potentially occlusive VV was found in 1.1% hearts and in all of which it coexisted with obstructive TV. The median CSO area was 87.9 mm2 [interquartile range (IQR): 56.5–127.1 mm2] and median CS length was 38 mm (IQR: 29.5–45 mm). The CSO area and CS length correlated with each other and with the right atrium’s dimensions.ConclusionWe identified six types of TVs, among which only 1.1% TVs caused total occlusion of CSO. The obstructive TV co-existed with potentially occlusive VV what might hinder CS cannulation.
Highlights
The coronary sinus (CS) is the central vein of the coronary venous system, which runs in the posterior part of the coronary groove as a continuation of the great cardiac vein from the Vieussens valve (VV) to its ostium located in the inferomedial part of the right atrium, between the inferior vena cava orifice and the inferior tricuspid annulus.[1,2]
Cardiovascular procedures using the CS as a gateway have significantly increased over the past decades, and successful CS cannulation constitutes a significant challenge in modern cardiology
The CS diameter was not related to the pulmonary arterial or right ventricle (RV) pressure or to the extent of tricuspid regurgitation, suggesting that the CS might behave as an extension of the right atrium (RA), like the inferior vena cava.[11]
Summary
The coronary sinus (CS) is the central vein of the coronary venous system, which runs in the posterior part of the coronary groove as a continuation of the great cardiac vein from the Vieussens valve (VV) to its ostium located in the inferomedial part of the right atrium, between the inferior vena cava orifice and the inferior tricuspid annulus.[1,2]. The CS opening is frequently covered by a fold of endocardial tissue termed the Thebesian valve (TV).
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
