Andersons pediatric cardiology 82
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ofthediaphragmaticsurfaceoftherightventricle,aswellasgivingrisetothe
inferiorinterventriculararteryandthearterytotheatrioventricularnode(Fig.
2.34).
FIG.2.34 Dissection,viewedfromaboveandfromtheleftside,withatrial
musculatureremovedandshowingthecourseofadominantcircumflex
arterywithintheleftatrioventriculargroove.Notethatthearterycontinues
beyondthecruxtosupplytheinferiorsurfaceoftherightventricle,andalso
givesrisetothearterytotheatrioventricularnode,whichextends
superiorlywithintheinferiorpyramidalspace.
CoronaryVeins
Thevenousreturnfromtheheartisforthemostpartcollectedbythemajor
cardiacveins,whichrunalongsidethecoronaryarteriesintheinterventricular
andatrioventriculargrooves.Thelargestvein,termedthegreatcardiacvein,
accompaniestheanteriorinterventricularartery,turningbeneaththeleftatrial
appendagetojointhecoronarysinus.Thejunctionbetweenveinandsinusisthe
pointofentranceoftheobliqueveinoftheleftatrium,ortheveinofMarshall,
whichusuallycorrespondswiththesiteofaprominentvenousvalve,thevalve
ofVieussens.Thecoronarysinusthenrunswithintheleftatrioventriculargroove
totherightatrium(Fig.2.35).
FIG.2.35 Arrangementofthemajorcoronaryveinsdrainingtothe
coronarysinus,asviewedfrombehind.
Asitenterstherightatrium,itcollectsthemiddlecardiacvein,which
accompaniestheinferiorinterventricularartery,andthesmallcardiacvein,
whichrunsintherightatrioventriculargroove.Furthersmallerveinsusually
drainintothesinusasitcourseswithintheleftatrioventriculargroove.When
thereisapersistentleftsuperiorcavalvein,itusuallydrainsintothecoronary
sinusalongtheroutenormallyoccupiedbytheobliquevein.Anadditionalseries
ofveins,theminorcardiacveins,usuallythreetofourinnumber,draintheblood
fromtheanteriorsurfaceoftherightventricleandentertheinfundibulum
directly.Afurtherseriesofminimalcardiacveins,orthebesianveins,thendrain
thebloodfromthewallsoftherightandleftatriums,openingdirectlyintothe
atrialcavities.
AnnotatedReferences
AndersonRH,BrownNA,WebbS.Development
andstructureoftheatrialseptum.Heart.
2002;88:104–110.
Inthisreview,weemphasizedthedifference
betweenthetrueatrialseptum,formedlargely
bytheflapvalve,whichcanberemovedwithout
creatingacommunicationwiththeextracardiac
spaces,asopposedtotheso-calledseptum
secundum,inrealitythesuperiorinteratrial
groove.Itispossibletopassbetweentheatrial
chambersbycuttingthroughthisfold,butonly
by,atthesametime,transgressingonthe
extracardiacspace..
AngeliniA,HoSY,AndersonRH,DaviesMJ,
BeckerAE.Ahistologicalstudyofthe
atrioventricularjunctioninheartswithnormal
andprolapsedleafletsofthemitralvalve.Br
HeartJ.1988;59:712–716.
Thisinvestigationshowedthatitwastheexception
ratherthantheruleforthemuralleafletofthe
mitralvalvetobesupportedbyacord-like
fibrousstructurethatalsoinsulatedtheatrial
fromtheventricularmyocardium..
CookAC,AndersonRH.Editorial.Attitudinally
