Thebesian valve: the guard dog of the coronary sinus?

Abstract

When the Silesian physician Adam Christian Thebesius described the valve guarding the ostium of the coronary sinus, he could hardly imagine that this structure would attract attention of many researchers and clinicians more than 300 years later.1 However, the advent of novel therapeutic techniques such as catheter ablation of cardiac arrhythmias, cardiac resynchronization therapy, and most recently percutaneous mitral repair have turned interest to this structure as an integral part of anatomy of the coronary sinus. The Thebesian valve is a caudal remnant of the embryonic sinoatrial valves. Whether it has any role in normal physiology is not known and some believe that it may prevent the regurgitation of blood into the sinus during the contraction of the atrium. However, experience from clinical practice suggests that the valve may pose difficulties in cannulation of the coronary sinus. Therefore, studies on anatomy of the Thebesian valve have potential practical implications. The paper by Mak et al. ,2 published in the current issue of the journal, provides another piece of knowledge in a mosaic. In a series of 75 autopsied human hearts (54 with organic heart disease), these authors confirmed a wide variety of Thebesian valve patterns. The valve was present in 73% of examined hearts. Most of these valves were membranous in composition (46%), followed by fibrous (24%), fibromuscular (11%), and muscular composition (18%). Fenestrations were noted in 26% of valves. Importantly, 16% of hearts showed a valve that … *Corresponding author. Tel: +420 261 365 009, Fax: +420 2 4172 82 25, Email: joka{at}medicon.cz