Clinical vignette
Two great cardiac veins: demonstration by computed tomography, conventional coronary angiography, and during surgery
Marc Dewey1*, Teodora Taubert2, Robert Hammerschmidt3, and Hans-Peter Dübel2
1Department of Radiology, Charité, Medical School, Freie Universität und Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; 2Department of Cardiology, Charité, Medical School, Freie Universität und Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; 3Department of Cardiac Surgery, German Heart Institute Berlin, Germany
*Corresponding author. Tel: +49 30 4505 27296; fax: +49 30 4505 27911. E-mail address: marc.dewey@charite.de.
A 62-year-old man with typical angina pectoris was referred for imaging of the coronary arteries to detect stenoses. Multislice computed tomography (CT) demonstrated significant coronary three-vessel disease. CT also depicted an anterior interventricular cardiac vein that did not follow the normal course of this vein parallel to the left circumflex coronary artery (LCX), but ran between the aorta and the left atrium parallel to the left main (LM) coronary artery and became a tributary of the superior vena cava (SVC) (upper arrow in Panel A, coronary arteries are bright and veins are red). There was a second great cardiac vein with a normal opening into the coronary sinus (lower arrow in Panel A). On a view from above the orifice of the abnormal coronary vein into the SVC could be well seen (arrow in Panel B, left and right atrium, LA, and RA). Because of the stenoses in the LM coronary artery, left anterior descending (LAD), and LCX (asterisks in Panels A and B), the patient subsequently underwent conventional coronary angiography that confirmed the coronary stenoses and the existence of two great cardiac veins (arrows in Panel C). This hitherto unknown coronary venous anomaly was confirmed during subsequent surgery necessary for coronary artery bypass grafting (view from above in Panel D). Anomalies of the coronary veins and their non-invasive visualization are increasingly important because they can serve as conduits for bypass surgery and for left ventricular epicardial lead placement to achieve biventricular pacing.
[Table of Contents]