Variant anatomy and spatial relationships of the structures of the cardiac venous system: a narrative review

Authors

DOI:

https://doi.org/10.14739/2310-1210.2026.4.350790

Keywords:

venous system, coronary sinus, variant anatomy, cardiac veins, Thebesian veins, angiology, anatomy, human

Abstract

Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide. Despite extensive research on the arterial cardiac vasculature, the venous system of the heart remains insufficiently studied, particularly with regard to its anatomical variability and complex spatial organization. The growing use of minimally invasive and interventional cardiology procedures highlights the clinical importance of detailed knowledge of cardiac venous morphology.

Aim. To summarize current morphofunctional data on the cardiac venous system, with emphasis on anatomical variability and spatial relationships among venous structures.

Materials and methods. A systematic review of scientific publications from the past 20 years was performed, including original studies, reviews, monographs, and electronic resources indexed in PubMed, Scopus, and Web of Science. The search employed the keywords: “coronary veins”, “coronary sinus”, “Thebesian veins”, “variant anatomy”, “cardiac venous system”, and “myocardial drainage”. Data were systematized according to the classification, topography, angioarchitecture, morphometry, and myocardial drainage pathways of the major and minor cardiac venous systems.

Results. The cardiac venous system consists of two interrelated components – the major and minor venous systems – responsible for drainage of the subepicardial and subendocardial myocardial layers, respectively. The coronary sinus, its tributaries, and major cardiac veins, including the great, middle, left marginal, small cardiac, and oblique vein of the left atrium, were analyzed. The Thebesian veins were identified as key elements of the intramyocardial venous network. Marked individual variability in venous angioarchitecture was observed, leading to differences in regional myocardial drainage.

Conclusions. Pronounced anatomical variability of the cardiac venous system underscores the need for detailed morphological evaluation when planning minimally invasive and interventional procedures. The summarized data have important practical implications for cardiologists, interventional surgeons, radiologists, and morphologists and may contribute to improved diagnostic and therapeutic strategies.

Author Biographies

T. V. Protsak, Bukovinian State Medical University, Chernivtsi

MD, PhD, Associated Professor of the Department of Mykola Turkevich Human Anatomy

I. S. Zabrodskyi, Bukovinian State Medical University, Chernivtsi

3rd year Student of Medical Faculty

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Published

2026-07-08

How to Cite

1.
Protsak TV, Zabrodskyi IS. Variant anatomy and spatial relationships of the structures of the cardiac venous system: a narrative review. Zaporozhye Medical Journal [Internet]. 2026Jul.8 [cited 2026Jul.13];28(4):380-6. Available from: https://zmj.zsmu.edu.ua/article/view/350790

Issue

Vol. 28 No. 4 (2026)

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Review

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Copyright (c) 2026 T. V. Protsak, I. S. Zabrodskyi

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