Coronary sinus
In anatomy, the coronary sinus (from Latin corona 'crown') is a collection of veins joined together to form a large vessel that collects blood from the heart muscle (myocardium). It delivers deoxygenated blood to the right atrium, as do the superior and inferior venae cavae. It is present in all mammals, including humans.
| Coronary sinus | |
|---|---|
 Back (posterior) side of the heart, with coronary sinus (blue) labeled | |
 Interior of heart, viewed anteriorly (opening of coronary sinus is labeled) | |
| Details | |
| Precursor | Sinus venosus |
| Source | Great cardiac vein |
| Drains to | Right atrium |
| Identifiers | |
| Latin | Sinus coronarius |
| MeSH | D054326 |
| TA98 | A12.3.01.002 |
| TA2 | 4158 |
| FMA | 4706 |
| Anatomical terminology | |
The coronary sinus drains into the right atrium, at the coronary sinus orifice, an opening between the inferior vena cava and the right atrioventricular orifice or tricuspid valve. It returns blood from the heart muscle, and is protected by a semicircular fold of the lining membrane of the auricle, the valve of coronary sinus (or valve of Thebesius). The sinus, before entering the atrium, is considerably dilated - nearly to the size of the end of the little finger. Its wall is partly muscular, and at its junction with the great cardiac vein is somewhat constricted and furnished with a valve, known as the valve of Vieussens consisting of two unequal segments.
Structure
The coronary sinus starts at the junction of the great cardiac vein and the oblique vein of the left atrium. The junction of the great cardiac vein and the coronary sinus is marked by the Vieussens valve. It is present in 65% to 87% of the population.[1][2] The coronary sinus runs transversely in the left atrioventricular groove on the posterior aspect of the heart.[3] The coronary sinus then drains into the posterior wall of right atrium. The orifice of the coronary sinus is located to the left of the orifice of inferior vena cava in the right atrium.[4]
The valve of the coronary sinus (also known as "Thebesian valve" is a thin, semilunar (half moon shape) valve located on the anteroinferior part of the opening into the right atrium. It is present in 73% to 86% of autopsied heart.[1]
- Tributaries :
- Great cardiac vein (run upwards in the anterior interventricular sulcus to the left atrioventricular groove to form the coronary sinus;[4]
- Middle cardiac vein (ascends posterior interventricular sulcus to drain into coronary sinus);[4]
- Small cardiac vein (accompanies right coronary artery in the right atrioventricular groove to drain into the right side of the coronary sinus;[4]
- Posterior vein of left ventricle (acccompanies the left marginal artery, ascends the posterior wall of left ventricle to drain into the coronary sinus);[4]
- Oblique vein of left atrium
Function
The coronary sinus receives blood mainly from the small, middle, great and oblique cardiac veins. It also receives blood from the left marginal vein and the left posterior ventricular vein. It drains into the right atrium.
The anterior cardiac veins do not drain into the coronary sinus but drain directly into the right atrium. Some small veins known as Thebesian veins drain directly into any of the four chambers of the heart.
Clinical significance
Electrodes can be inserted into and through the coronary sinus to study the electrophysiology of the heart. This includes for a coronary sinus electrogram.[3] The coronary sinus connects directly with the right atrium. It will dilate as a result of any condition that causes elevated right atrial pressure, such as pulmonary hypertension.[5] Dilated coronary sinus is also seen in some congenital cardiovascular conditions, such as persistent left supervisor cava,[6] and total anomalous pulmonary venous return.[7]
Additional images
Diagram showing completion of development of the parietal veins.
Posterior view of coronary circulation
References
- Shah, Sanket S.; Teague, Shawn D.; Lu, Jimmy C.; Dorfman, Adam L.; Kazerooni, Ella A.; Agarwal, Prachi P. (July 2012). "Imaging of the Coronary Sinus: Normal Anatomy and Congenital Abnormalities". RadioGraphics. 32 (4): 991–1008. doi:10.1148/rg.324105220. ISSN 0271-5333.
- McAlpine, W. A. (2012). Heart and Coronary Arteries: An Anatomical Atlas for Clinical Diagnosis, Radiological Investigation, and Surgical Treatment. Springer Science & Business Media. ISBN 9783642659836.
- Issa, Ziad F.; Miller, John M.; Zipes, Douglas P. (2019-01-01), Issa, Ziad F.; Miller, John M.; Zipes, Douglas P. (eds.), "4 - Electrophysiological Testing: Tools and Techniques", Clinical Arrhythmology and Electrophysiology (Third Edition), Philadelphia: Elsevier, pp. 81–124, ISBN 978-0-323-52356-1, retrieved 2021-01-12
- Ryan, Stephanie (2011). "Chapter 3". Anatomy for diagnostic imaging (Third ed.). Elsevier Ltd. p. 137. ISBN 9780702029714.
- Mahmud E, Raisinghani A, Keramati S, Auger W, Blanchard DG, DeMaria AN. "Dilation of the coronary sinus on echocardiogram: prevalence and significance in patients with chronic pulmonary hypertension". J Am Soc Echocardiogr. 2001 Jan;14(1):44–49. doi:10.1067/mje.2001.108538. PMID 11174433.
- Savu C, Petreanu C, Melinte A, Posea R, Balescu I, Iliescu L, Diaconu C, Galie N, Bacalbasa N. "Persistent Left Superior Vena Cava – Accidental Finding". In Vivo. 2020 Mar–Apr;34(2):935–941. doi:10.21873/invivo.11861. PMID 32111807 PMC PMC7157846.
- Gupta A, Mishra A, Shrivastava Y. "Repair of intracardiac total anomalous pulmonary venous return". Multimed Man Cardiothorac Surg. 2021 Mar 8;2021. doi:10.1510/mmcts.2021.015. PMID 33904266
External links
- Anatomy figure: 20:04-03 at Human Anatomy Online, SUNY Downstate Medical Center – "Posterior view of the heart."
- MedEd at Loyola Radio/curriculum/Vascular/Coronary_sinus.jpg
