Abstract
A 64-year old woman was referred to the division of cardiology due to recurrent angina pectoris (CCS III). The patient’s symptoms and high cardiovascular risk profile were an indication for coronary angiography. Relevant coronary heart disease was hereby ruled out; however, angiography showed a direct drainage of coronary vessels into the chambers. These Thebesian veins are of venoluminal nature in most cases and have a clinical implication in selected cases only.
Highlights
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Angiography showed a direct drainage of coronary vessels into the chambers
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Thebesian veins are of venoluminal nature in most cases
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Thebesian veins have a clinical implication in selected cases only, e.g. cardioplegia and right-to-left shunting
1
Introduction
The majority of the venous blood of the heart is returned by epicardial coronary veins and ultimately flows through the coronary sinus into the right atrium. We report the case of a patient complaining of chest pain who underwent angiography due to suspected coronary artery disease. Angiography ultimately revealed an additional venous system, the casa cordis minimae.
2
Case report
A 64-year old woman was referred to the division of cardiology due to recurrent chest pain. On admission, she complained of angina associated with everyday activities (CCS III) . She denied having dyspnoea, palpitations, or syncope. The patient’s comorbidities included arterial hypertension, hypercholesterolemia, and smoking (21 pack years).
Transthoracic echocardiography showed normal left ventricular systolic function (LVEF 65%) and diastolic dysfunction. It did not show any relevant valve disorders or septal defects. Due to the patient’s symptoms and high cardiovascular risk profile coronary angiography was performed. The angiogram showed tortuous arteries with only minor atherosclerosis (see Fig. 1 and Moving Images 1–4 ). There was no significant stenosis; however, direct drainage of coronary blood into the chambers, commonly referred to as veins of Thebesian, was observed (see Fig. 2 ). This phenomenon affects not only the left but also the right coronary system (see Moving Images 1–4 ). Drainage of blood into the left ventricle appeared to be greater as assessed by non-quantitative angiography (see Moving Images 1–2 ).
2
Case report
A 64-year old woman was referred to the division of cardiology due to recurrent chest pain. On admission, she complained of angina associated with everyday activities (CCS III) . She denied having dyspnoea, palpitations, or syncope. The patient’s comorbidities included arterial hypertension, hypercholesterolemia, and smoking (21 pack years).
Transthoracic echocardiography showed normal left ventricular systolic function (LVEF 65%) and diastolic dysfunction. It did not show any relevant valve disorders or septal defects. Due to the patient’s symptoms and high cardiovascular risk profile coronary angiography was performed. The angiogram showed tortuous arteries with only minor atherosclerosis (see Fig. 1 and Moving Images 1–4 ). There was no significant stenosis; however, direct drainage of coronary blood into the chambers, commonly referred to as veins of Thebesian, was observed (see Fig. 2 ). This phenomenon affects not only the left but also the right coronary system (see Moving Images 1–4 ). Drainage of blood into the left ventricle appeared to be greater as assessed by non-quantitative angiography (see Moving Images 1–2 ).
