Middle cardiac vein !

The middle cardiac vein runs in the groove on the underside of the heart, beside the posterior descending artery, and drains into the coronary sinus.

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What it is

Runs in the posterior interventricular groove, from the apex up to the coronary sinus, side by side with the posterior descending artery.

What it does

Drains the back (diaphragmatic) wall of both ventricles and the back of the septum.

Key facts

Drains: Inferior (diaphragmatic) walls of both ventricles and the posterior septum, running with the PDA in the posterior interventricular groove
Into: Right end of the coronary sinus, near its opening into the right atrium

Relations

Below: Diaphragmatic surface of the heart, resting on the central tendon of the diaphragm
Deep: Posterior (inferior) part of the interventricular septum

How to find it

Seen when the heart is lifted to expose its diaphragmatic surface: it runs up the posterior interventricular groove beside the posterior descending artery and ends in the coronary sinus a short way from its opening into the right atrium.

On imaging

Coronary sinus venography and CT venography show it climbing the posterior interventricular groove from the apex to the sinus.

Common problems

Rarely a problem on its own.

Clinical notes

Because the posterior descending artery runs right beside it, ablation inside the vein carries a risk of injuring the artery
Because it joins the sinus so close to the ostium, a retrograde cardioplegia balloon placed deep in the sinus can sit beyond its opening and leave the inferior wall and septum less well protected

Anatomical variants

It may open directly into the right atrium instead of the coronary sinus
A coronary sinus diverticulum near its entry is associated with posteroseptal accessory pathways

Test yourself

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

In which groove does the middle cardiac vein run, and with which artery?

The posterior interventricular groove, beside the posterior descending artery.

Where does the middle cardiac vein enter the coronary sinus?

At its right end, close to its opening into the right atrium, so it is the first large tributary a catheter meets.

Why does ablation inside the middle cardiac vein carry a risk to the coronary circulation?

The posterior descending artery runs right beside the vein and can be injured.

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

Its names

Official Latin (TA2): vena media cordis TA2 4165
Official Spanish (DeCS): Vena cardíaca media
English (TA2): Middle cardiac vein
Also called: posterior interventricular vein · inferior interventricular vein · vena cordis media · vena interventricularis dorsalis cordis

Sources: Terminologia Anatomica (TA2); Anatomy, Thorax, Heart Veins; Anatomy, Thorax, Coronary Sinus.

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Representative model, for educational purposes only.