Coronary sinus

The coronary sinus is the largest cardiac venous structure. It returns the majority of the blood supply for the left ventricle to the right atrium.

Gross anatomy

The coronary sinus courses along the posterior wall of the left atrium into the left atrioventricular groove. It normally drains into the right atrium. The ostium of the coronary sinus is partially covered by the Thebesian valve.

Veins draining into the coronary sinus are highly variable, but usually, include:

• great cardiac vein
• middle cardiac vein (posterior interventricular vein)
• small cardiac vein
• posterior vein of the left ventricle
• left atrial oblique vein (of Marshall)
• left marginal vein

Development

The coronary sinus develops from one of the two sinus horns of the sinus venosum. The other horn becomes part of the right atrium. The right venous valve of the sinus venosum develops into the thebesian valve and the Eustachian valve.

Variant anatomy

• the coronary sinus may act as a conduit between a persistent left superior vena cava and the right atrium
• rarely, the coronary sinus may drain into the left atrium, causing a left-to-right shunt (or right-to-left in cases of right heart failure)

Related pathology

The coronary sinus may be involved in a number of different procedures or pathologic processes:

• the coronary sinus is a good position for lead placement in biventricular pacing
• the coronary sinus may be an ablation target for some arrhythmia/dysrhythmias (e.g. Wolff-Parkinson-White syndrome)
• the coronary sinus rarely may have an abnormal connection to the left atrium on its way to the right atrium (unroofed coronary sinus), a rare kind of atrial septal defect
  • associated with heterotaxy syndromes and persistent left-sided superior vena cava

Siehe auch:

• persistierende linke obere Hohlvene
• Vena cardiaca magna
• Sinus aortae
• Koronararterien
• Valvula thebesii
• Sinus coronarius Sonde
• Vena cardiaca media
• Vena cardiaca parva
• Venae cardiacae minimae
• Koronarvenen

und weiter:

• ICD Sondenlage
• Koronarsinusdefekt (unroofed coronary sinus)