A 52-year-old woman presented with chest pain from spontaneous coronary artery dissection of the distal segment of the first diagonal branch of the left anterior descending coronary artery. We performed left ventriculography, injecting 20 mL of contrast medium at 10 mL/s through a 5F, 100-cm Performa® Ultimate 1 diagnostic cardiac catheter with bumper tip and wire-braid design (Merit Medical Systems, Inc.). The opacified left ventricle (LV) showed mild anterolateral hypokinesis (estimated LV ejection fraction, 0.50). The catheter moved during the procedure, inadvertently cannulating a Thebesian vein with contrast injection (Fig. 1). The dye cleared in 30 seconds. The patient was discharged from the hospital the next day, in stable condition.

Fig. 1

Left ventriculogram shows inadvertent cannulation of a Thebesian vein, with contrast injection. The dye cleared in 30 seconds.

Supplemental motion image is available for Figure 1.

Fig. 1

Left ventriculogram shows inadvertent cannulation of a Thebesian vein, with contrast injection. The dye cleared in 30 seconds.

Supplemental motion image is available for Figure 1.

Comment

Described first by Vieussens1  in 1706 and in detail by Thebesius2  in 1708, Thebesian veins are rare intracardiac venous channels without valves. They enable direct communication between the heart chambers and the venous system or coronary arteries. They are thought to be more prevalent in the atria than in the ventricles and more prevalent in the right ventricle than in the LV.3 

We incidentally encountered a rare LV Thebesian vein while performing left ventriculography. Our report includes a clinical angiographic video that shows LV Thebesian venous channels.

References

References
1.
Vieussens
R.
Nouvelles decouvertes sur le Coeur (New discoveries on the heart) [in French]
.
Toulouse (France)
:
Jean Guillmette
;
1706
.
2.
Thebesius
AC.
Disputatio medica inauguralis de circulo sanguinis in corde
.
Lugduni Batavorum
;
1708
.
3.
Aqel
R,
Gupta
R,
Zoghbi
GJ.
Images in cardiology: Thebesian venous lake
.
Heart
2005
;
91
(
10
):
1318
.

Author notes

Section Editor: Raymond F. Stainback, MD

Supplementary data