Great Cardiac Vein

vena cardiaca magna

The great cardiac vein runs alongside the left anterior descending artery in the anterior interventricular groove and then turns posteriorly alongside the left circumflex artery in the atrioventricular groove before joining the oblique vein of Marshall to become the coronary sinus. It is the largest tributary of the coronary sinus, draining the anterior left ventricle, the anterior septum, and portions of the posterior left ventricle.

Region: Chest

Clinical Relevance

Clinical Notes

The great cardiac vein is the first structure encountered when cannulating the coronary sinus for CRT lead placement. Posterior or posterolateral branches of the great cardiac vein are the target vessels for left ventricular lead positioning in cardiac resynchronisation therapy. The great cardiac vein parallels the LAD and LCx and is at risk during cardiothoracic surgery in the anterior atrioventricular groove. The angle between the great cardiac vein and its tributaries determines the feasibility of reaching optimal lead positions for CRT.

Pathology

Common Injuries & Conditions

Great Cardiac Vein Injury in LAD Surgery

The great cardiac vein runs parallel to the LAD in the anterior interventricular groove and is at risk during surgical dissection for CABG harvest of the LAD bypass target or during epicardial lead placement, where inadvertent venous injury causes haemorrhage controlled by direct suture.