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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Veins: Head, Neck, and Thorax: Coronary Sinus

Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Veins: Head, Neck, and Thorax

Coronary Sinus

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed

The coronary sinus receives the great, middle, and small cardiac veins: posterior vein of the left ventricle; the oblique vein of the left atrium. The tributaries to the coronary sinus are variable and the coronary sinus may receive all cardiac veins, except the venae minimae, including the anterior cardiac veins (33% of cases studied). Some of the anterior cardiac veins may drain into the small cardiac vein, which enters the coronary sinus (28% of cases). The remaining 39% have the "usual" pattern of drainage described above.

It has been reported that the valve of the coronary sinus (Thebesius) may be semilunar in shape (73/143), cribriform (7/143) or septal-shaped (10/143) or it may be absent (53/143) in one study of adults (103/143), teenagers (32/143), pre-teens (3/143), and newborn (5/143) hearts.

The coronary sinus may be obliterated or absent. The great cardiac vein then drains into the superior vena cava or left brachiocephalic vein via the oblique vein of Marshall.

Several veins, including the middle cardiac vein, may converge to empty into a common opening into the right atrium.

In the absence of the ostium for the coronary sinus, the blood carried in the cardiac veins may reach the right atrium of the heart by passing successively through a left (persistent) superior vena cava, left innominate vein, and right superior vena cava.

The coronary sinus may open into the left atrium.

In one study, two of 150 (1.33%) hearts lacked a valve.

The coronary sinus has been reported to be as long as 5.4 cm but is usually about 2.5 cm in length. According to the Piffer, et al study, the coronary sinus varied between 0.2 to 0.9 cm in length.

Image 51, Image 202, Image 203, Image 217, Image 368, Image 368A, Image 392

Absence of

Image 217, See Image 392


See Image 202


Anson, B.J., Ed. (1966) Morris' Human Anatomy, 12th ed., The Blakiston Division, McGraw -Hill Book Company, New York.

Bergman, R.A., Thompson, S.A. and F.A. Saadeh. (1988) Absence of the coronary sinus. Anat. Anz. 166:9-12.

Bergman, R.A., Thompson, S.A., Afifi, A.K. and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. Urban & Schwarzenberg, Baltimore and Munich.

Hellerstein, H.K. and J.L. Orbison. (1951) Anatomic variations of the orifice of the human coronary sinus. Circulation 3:514-523.

Kocon, T. (1963) A rare variation of the coronary sinus. Folia Morphol., Warsaw 22:11-14.

Little, T.E. (1880) Abnormality of the great cardiac vessels. Dublin Journal of Medical Science 60:443-445.

Malhotra, V.K., Tewari, S.P., Tewari, P.S. and S.K. Agarwal. (1980) Coronary sinus and its distribution. Anat. Anz. 148:331-332.

Peele, T.L. (1932) A case of closed coronary sinus and left superior vena cava. Anat. Rec. 54:83-86.

Prows, M.S. (1942) Two cases of bilateral superior vena cava, one draining a closed coronary sinus. Anat. Rec. 87:99-106.

Roberts, W.H., Engen, P. and E. Fujimoto. (1980) Anomalous opening of coronary sinus into the left atrium. Anat. Anz. 147:471-472.

Sahinoglu, K., Cassell, M.D., Miyauchi, R. and R.A. Bergman. (1994) Human persistent left superior vena cava with doubled coronary sinus. Annals Anat. 176:451-454.

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