Thebesian veins in the human hearts with atherosclerotic lesions in the coronary arteries

The effects of retrograde cardioplegia technique on myocardial perfusion and energy metabolism: A magnetic resonance imaging and localized phosphorus 31 spectroscopy study in isolated pig hearts

“…It has been demonstrated that coronary arterial disease stimulates the development of the venous anastomoses. 6 Therefore, it is possible that the actual distribution of retrograde cardioplegic solution with DCSC in diseased human hearts may be better than that observed in this study. Therefore, extrapolating the data of this study to clinical situations must be done with caution.…”

“…It has been demonstrated that the coronary venous system is not affected by atherosclerosis and that the nutritional flow of retrograde perfusion may be sufficient to sustain myocardial energy demands of the arrested heart. [4][5][6]18 This fact, along with the absence of instruments in the operative field, has made retrograde cardioplegia an alternative for myocardial protection. As mentioned above, retrograde cardioplegia can be administered in various modalities.…”

“…Inasmuch as the coronary venous system is not affected by atherosclerosis, retrograde cardioplegia may be better than antegrade cardioplegia in protecting the jeopardized myocardium supplied by occluded coronary arteries. [6][7][8] Retrograde cardioplegia can be carried out through various means. Some surgeons deliver cardioplegic solution through a retrograde catheter placed far into the coronary sinus with a balloon fully inflated to ensure proper wedging of the catheter in the coronary lumen (we refer to this technique as deep coronary sinus cardioplegia [DCSC]).…”

Does antegrade blood cardioplegia alone provide adequate myocardial protection in patients with left main stem disease?

“…Several authors 9 argue that experimental studies on retrograde cardioplegia performed in dogs may be of questionable relevance because of the differences in canine anatomy with predominant venous drainage by way of thebesian veins rather than the coronary sinus. Moreover, other investigators 10 have found a larger number of thebesian veins and other venous channels in patients with a coronary atherosclerotic obstruction, and 70% of such patients can be shown to have increased coronary arteriovenous shunts.…”