Great cardiac vein !

The great cardiac vein runs up the front of the heart beside the anterior descending artery; it drains the front of the heart into the coronary sinus.

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What it is

The main vein of the front of the heart. It starts near the apex, climbs the anterior interventricular groove beside the LAD, then turns left in the atrioventricular groove beside the circumflex to end in the coronary sinus.

What it does

Drains the front of both ventricles, most of the septum and the left atrium into the coronary sinus.

Key facts

Drains: Anterior walls of both ventricles and the septum: rises with the LAD in the anterior interventricular groove, then turns left with the circumflex in the coronary groove
Into: Left end of the coronary sinus (at the valve of Vieussens and the oblique vein of the left atrium)

Relations

Above: Left auricle, under which it turns into the coronary groove
Deep: Interventricular septum and the base of the left ventricle
Course: Starts near the apex as the anterior interventricular vein beside the LAD, climbs the anterior interventricular groove, turns left into the coronary groove alongside the circumflex artery and becomes the coronary sinus at the oblique vein of the left atrium

How to find it

At surgery it is visible under the epicardium in the anterior interventricular groove beside the left anterior descending artery, then curves left in the atrioventricular groove alongside the circumflex artery toward the back of the heart. Catheters reach it through the coronary sinus ostium in the right atrium.

On imaging

Coronary sinus venography (contrast through a balloon catheter) or CT venography shows it and its tributaries before resynchronization or ablation.

Common problems

Rarely a problem on its own.

Clinical notes

Premature beats and ventricular tachycardia from the left ventricular summit can be mapped and ablated from inside the vein, where it runs close to the LAD and circumflex artery
Retrograde cardioplegia, given through a balloon catheter in the coronary sinus, reaches the anterior and lateral wall of the left ventricle through this vein during heart surgery
Devices for mitral annuloplasty placed through the coronary sinus and this vein can squeeze the circumflex artery where it passes beneath the vein, so the artery is checked by angiography during the procedure

Anatomical variants

The number, size and course of its tributaries vary widely, which matters when choosing a site for the resynchronization lead

Test yourself

Think of the answer, then tap the question to see it.

What course does the great cardiac vein follow?

It rises with the left anterior descending artery in the anterior interventricular groove, then turns left with the circumflex in the coronary groove.

Where does the great cardiac vein become the coronary sinus?

Where it receives the oblique vein of the left atrium, a point often marked by the valve of Vieussens.

Which tributary of the great cardiac vein is a frequent site for the left ventricular lead in cardiac resynchronization?

The left marginal vein, which runs along the obtuse margin.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): vena magna cordis TA2 4159
Official Spanish (DeCS): Vena cardíaca magna
English (TA2): Great cardiac vein
Also called: anterior interventricular vein (its first part) · vena cordis magna

Sources: Terminologia Anatomica (TA2); Anatomy, Thorax, Heart Veins; Anatomy, Thorax, Coronary Sinus; Tratado de anatomía humana (9.ª ed.), tomo II, Libro IV Angiología, sección 1, cap. I Corazón (arts. VI–IX) y cap. II Pericardio.

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Representative model, for educational purposes only.