Variations in Thebesian valve anatomy and coronary sinus ostium: implications for invasive electrophysiology procedures

Abstract

Our study shows that some form of Thebesian valve is present in the majority of hearts (>70%). Of these, a significant minority (16%) had a valve morphology (covering >75% of the ostium, a fibrous, fibromuscular, or muscular composition, and devoid of fenestrations) that makes them a 'potentially complicating' structure interfering with the cannulation of the CS.

Anatomy of coronary sinus ostium

“…The presented data are in concordance with our results. All these studies confirm the significant variability in the presence and arrangement of the TV [3,4,6,7,[9][10][11][12]. This study is the first one of this kind carried out in our country on our population.…”

“…Mak et al [10] published the results from 75 autopsied human hearts (54 with organic heart disease), that confirmed a wide variety of TV patterns. The valve was present in 73% of examined hearts, and the most common shape was semicircular (65.4%).…”

“…Anatomical variations of the CSO and the TV are numerous, and, as many authors have reported, the valve at the entrance to the CS could pose difficulties in cannulation of the CS [3,4,6,7,[9][10][11][12]. It has been suggested that the role of the TV in normal physiology is to prevent the regurgitation of blood into the The TV is always described in anatomy textbooks, but it is hard to find detailed systematic studies of its structure and function.…”

“…It ends in the right atrium, between the opening of the inferior vena cava and the atrioventricular aperture. Its orifice (coronary sinus ostium [CSO]) is 5-15 mm in diameter and it is often guarded by a fold of endocardial tissue, an embryological remnant of the caudal portion of the right valve of the embryonic sinoatrial orifice, termed the valve of the CS or Thebesian valve (TV) [9,10].…”

The Thebesian valve and its significance for electrophysiologists

“…The Thebesian valve has been identified in a significant number of hearts examined by various researchers [2,8]. In their study on 54 hearts obtained from patients with atherosclerosis, cardiomyopathy, left ventricular enlargement and endocarditis, Mak et al [11] observed the CS valve in 73% of specimens. Meanwhile, Pejkovic et al [15] identified the Thebesian valve in 80% of their sample.…”