The Prognosis of Thebesian Veins Can Be Obfuscated by Conflating the Vessels (Veins) of Thebesius With Coronary Artery-Cameral Connections

Abstract

The prognostically insightful article by Snipelski et al 1 Snipelisky D. Reddy Y.N. Lennon R.J. Crusan D.J. Rihal C.S. Lapeyre 3rd, A.C. Cardiac Structural changes and long-term survival in patients with prominent Thebesian veins. Am J Cardiol. 2016; 118: 1264-1267 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar may have some limitations as the authors conflated arteries with veins by labeling every coronary artery-cameral communication that they identified on coronary “artery” angiography as a “Thebesian vein.” However, some of the connections identified by the authors are presumably the arteriosinusoidal and arterioluminal vessels (arteries) reported by Wearn et al. 2 Grollman Jr., J.H. Re: three major coronary artery-to-left ventricular shunts. Cardiovasc Intervent Radiol. 1998; 21: 183 Crossref PubMed Scopus (5) Google Scholar , 3 Wearn J.T. Mettier S.R. Klumpp T.G. Zschiesche L.J. The nature of the vascular communications between the coronary arteries and the chambers of the heart. Am Heart J. 1933; 9: 143-164 Abstract Full Text PDF Google Scholar Parenthetically, Thebesius studied connections between the coronary veins and heart chambers. 4 Thebesius A. Disputatio medica inauguralis de circulo sanguinis in corde. Lugduni Batavorum, Leiden1708 Google Scholar Because a capillary bed usually separates the coronary arteries from the coronary veins, the 2 distinct types of vessels, arteries and veins, probably should not be used interchangeably. 5 James T.N. The delivery and distribution of coronary collateral circulation. Chest. 1970; 58: 183-203 Crossref PubMed Scopus (66) Google Scholar With regards to eponyms, “Thebesian” should only be used to describe the coronary vein-cameral connections that he studied. 4 Thebesius A. Disputatio medica inauguralis de circulo sanguinis in corde. Lugduni Batavorum, Leiden1708 Google Scholar Lurie's plea for accurate nomenclature continues to be echoed. 6 Lurie P.R. The perspective of ventricular noncompaction as seen by a nonagenarian. Cardiol Young. 2008; 18: 243-249 Crossref PubMed Scopus (13) Google Scholar , 7 Hussain M. Roberts E.B. Association of coronary to left ventricular microfistulae (vessels of Wearn) with atrial septal defect in an adult without cyanotic heart disease. BMJ Case Rep. 2015; http://dx.doi.org/10.1136/bcr-2014-207655 Google Scholar Instead of trying to discern between arteries and veins on angiography, it may be simpler to describe the connections as “Thebesian-like vessels.” The impact could be increased if studies such as this 1 Snipelisky D. Reddy Y.N. Lennon R.J. Crusan D.J. Rihal C.S. Lapeyre 3rd, A.C. Cardiac Structural changes and long-term survival in patients with prominent Thebesian veins. Am J Cardiol. 2016; 118: 1264-1267 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar were clearly related to cases in which the histopathologic changes are also described. Referring to arteries as veins has been reported to cause confusion. 8 Ahmed A.A. Snodgrass B.T. Kaine S. Pulmonary atresia with intact ventricular septum and right ventricular dependent coronary circulation through the “vessels of Wearn”. Cardiovasc Pathol. 2013; 22: 298-302 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar ReplyAmerican Journal of CardiologyVol. 120Issue 3PreviewThe authors thank Dr. Snodgrass for highlighting the difficulty of medical nomenclature especially as it relates to the use of the term “Thebesian Veins” in the coronary angiographic literature rather than “Thebesian-like vessels.” Wearn studied the role of Thebesian vessels and showed that under certain conditions up to 90% of coronary blood flow may pass through the Thebesian veins.1 In that study, Wearn described 3 types of Thebesian connections: “(1) the direct connection between the arteries and the Thebesian vessels, as shown by the celloidin injections, (2) the venous connection with Thebesian vessels, and (3) the capillaries which run directly into the Thebesian vessels.” Angiographically without histopathologic analysis of tissue, it is therefore difficult if not impossible to differentiate “Thebesian” flow from flow thorough “Vessels of Wearn,” which Wearn described later. Full-Text PDF Cardiac Structural Changes and Long-Term Survival in Patients With Prominent Thebesian VeinsAmerican Journal of CardiologyVol. 118Issue 8PreviewAlthough rare, numerous case reports suggest that Thebesian veins confer increased morbidity and mortality. No study has evaluated their effects on cardiac structure or long-term patient outcomes. Patients undergoing coronary angiogram at the study institution from October 2002 and January 2015 were assessed for a diagnosis of prominent Thebesian veins. A matched control group was created and comparisons between clinical, echocardiographic, and survival measures were made. Of 50,116 total patients, 31 (0.06%) were found to have prominent Thebesian veins on angiography and were compared with a matched control group of 596 patients. Full-Text PDF