Key result
Anatomical assessment of 560 cadaveric hearts identified six types of Thebesian valves (present in 79.5%), with 1.1% causing total occlusion of the coronary sinus ostium.
Why the study?
Cardiovascular procedures accessing the coronary sinus are increasing, creating a need to define specific coronary sinus structures that could complicate cannulation and to establish a Thebesian valve classification system.
Observational (n=560)
Anatomical variations in the Thebesian and Vieussens valves are common, but totally occlusive structures that might prevent coronary sinus cannulation are rare (1.1%).
TV variants may impede CS cannulation; leaves open clinical utility of the new classification.
AIMS: The number of cardiovascular procedures using the coronary sinus (CS) as a gateway is constantly increasing. The present study aimed to define specific structures within CS, which could potentially complicate CS cannulation and to develop a new Thebesian valve (TV) classification system. METHODS AND RESULTS: The study was performed on 560 consecutive unfixed cadaveric hearts during routine autopsy examination (1-3 days post-mortem). Basic CS dimensions were measured and the presence and dimensions of the TV and the Vieussens valve (VV) were assessed. Thebesian valves were classified according to their morphology into six main types: remnant fold, semilunar, fenestrated, chord, fused strands, and mixed shaped. The median age of hearts was 48 years (range 16-95 years), and 38.9% were female. Thebesian valve was present in 79.5%. The most common TV type was semilunar (54%) followed by fenestrated (8.2%), remnant fold (5.5%), fused strands (4.8%), chord (4.0%), and mixed shaped (3.0%). In 1.1% of hearts, TV totally covered the coronary sinus ostium (CSO). The VV was detected in 67.9%. Potentially occlusive VV was found in 1.1% hearts and in all of which it coexisted with obstructive TV. The median CSO area was 87.9 mm2 [interquartile range (IQR): 56.5-127.1 mm2] and median CS length was 38 mm (IQR: 29.5-45 mm). The CSO area and CS length correlated with each other and with the right atrium's dimensions. CONCLUSION: We identified six types of TVs, among which only 1.1% TVs caused total occlusion of CSO. The obstructive TV co-existed with potentially occlusive VV what might hinder CS cannulation.
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Sławek-Szmyt et al. (2021) conducted an observational in Coronary sinus anatomy (n=560). Anatomical assessment of the coronary sinus was evaluated on Presence, dimensions, and morphology of the Thebesian valve and Vieussens valve. Anatomical assessment of 560 cadaveric hearts identified six types of Thebesian valves (present in 79.5%), with 1.1% causing total occlusion of the coronary sinus ostium.
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