CORONARY VENOUS SYSTEM DISEASES

Coronary_Venous_System_Diseases

EMBRYOLOGY OF THE CORONARY VENOUS SYSTEM

Özge Turgay Yıldırım1 Mehmet Özgeyik2

1Eskişehir City Health Application and Research Center, Department of Cardiology, Eskişehir, Türkiye
2Eskişehir City Health Application and Research Center, Department of Cardiology, Eskişehir, Türkiye

Turgay Yıldırım Ö, Özgeyik M. Embryology of the Coronary Venous System. In: Altay S, Akşit E, Kemaloğlu Öz T editor. Coronary Venous System Diseases. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.1-8.

ABSTRACT

The coronary venous system, essential for removing myocardial metabolic waste and returning blood to the right atrium, holds significant importance in diagnostic and interventional cardiology. It serves as a critical access route for procedures such as cardiac resynchronization therapy, retrograde cardioplegia delivery, and other diagnostic interventions. A thorough understanding of the embryological events behind the development of this system is vital for diagnosing and managing related diseases and anomalies. The coronary venous network is formed through the intricate remodeling of the sinus venosus and the primitive subepicardial vascular plexus, guided by molecular pathways such as VEGF, Eph/ Ephrin, COUP-TFII, and Notch signaling. These pathways regulate endothelial proliferation, vascular plexus remodeling, and venous identity in response to hemodynamic forces.

The coronary sinus, a central structure in this network, emerges from the left sinus horn and parts of the left anterior cardinal vein. In contrast, its tributaries—the great, middle, and small cardiac veins— originate independently from the subepicardial vascular plexus, which forms from epicardium-derived cells. Channel selection within this plexus ensures the formation of major veins, with molecular guidance and hemodynamic forces directing venous patterning and connection to the coronary sinus or right atrium. Errors in this complex progression can result in anomalies such as persistent left superior vena cava, coronary sinus atresia, and unroofed coronary sinus, disrupting cardiac venous return and potentially leading to clinical challenges.

The detailed knowledge of these embryological mechanisms not only furthers understanding of congenital disorders and acquired diseases but also establishes a foundation for safe and effective interventional strategies. This chapter emphasizes the anatomical and molecular intricacies of coronary venous development, linking them to clinically relevant scenarios to aid better diagnostic and therapeutic outcomes in modern cardiology.

Keywords: Coronary vessels; Embryology; Coronary sinus; Cardinal veins; Vascular endothelial growth factor A; COUP transcription factor II

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