Permanent left ventricular pacing from the great cardiac vein of a patient with artificial tricuspid and mitral valves--a case report

Great cardiac vein variations

A novel variation in the relationship of the great cardiac vein to the circumflex artery was observed in an otherwise normal cadaver heart. Vessels originated and terminated normally, but in their midcourse they were twisted around each other such that each made one complete loop around the other. This variation did not seem to be involved in any pathologies. Variations in the course of the great cardiac vein have been little studied until recently, but their simplicity emphasizes the uniqueness of our intertwined case. Commonly, the great cardiac vein varies with respect to presence, location, and the superficial or deep relationship of single crossings of the anterior interventricular and circumflex arteries. Although rare, the intertwined variation described in the present case may have important basic science implications for understanding mechanisms of vasculo-angiogenesis, and clinical implications for catheter-based procedures and surgeries in the region of the coronary sulcus. Also, a review of great cardiac vein variations is presented herein.