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Anterior interventricular sulcus

The anterior interventricular sulcus is a prominent groove on the sternocostal (anterior) surface of the heart, marking the external boundary between the right and left ventricles. It runs obliquely downward from the coronary sulcus near the left auricle toward the apex of the heart, where it meets the posterior interventricular sulcus.

This sulcus contains key vascular structures, most notably the left anterior descending artery (LAD, anterior interventricular branch of the left coronary artery) and the great cardiac vein. It is also partly filled with epicardial fat, which cushions and protects these vessels. Because the LAD runs within this sulcus, the region is of critical clinical importance, as LAD disease can compromise perfusion to the anterior ventricular wall, interventricular septum, and cardiac apex.

Synonyms

  • Anterior interventricular groove

  • Sulcus interventricularis anterior

  • LAD groove

Function

  • Serves as an anatomical landmark separating the right and left ventricles externally

  • Provides a protective pathway for the LAD artery and great cardiac vein

  • Marks the course of critical vessels for cardiac imaging, surgery, and interventions

  • Guides surgeons and radiologists in localizing myocardial perfusion territories

Contents

  • Left anterior descending artery (LAD) → major arterial supply to anterior LV wall, anterior 2/3 of interventricular septum, apex

  • Great cardiac vein → drains blood from anterior left ventricle and septum

  • Epicardial fat surrounding the vessels

MRI Appearance

T1-weighted images:

  • Sulcus appears as a fat-filled groove with intermediate to high signal intensity (fat signal)

  • Vessels (LAD and great cardiac vein) appear as flow voids (black lumina) within the fat plane

T2-weighted images:

  • Fat remains hyperintense; flowing blood within LAD and great cardiac vein shows signal voids

  • Pathological perivascular edema or infiltrates may appear as hyperintensity in the sulcus

STIR (Short Tau Inversion Recovery):

  • Fat suppression reduces the bright epicardial fat, improving contrast

  • Vessel margins more clearly defined

  • Abnormal tissue (edema, inflammation, infiltration) appears bright hyperintense within or adjacent to the sulcus

T1 Post-Contrast (Gadolinium-enhanced):

  • LAD artery and great cardiac vein demonstrate vascular enhancement

  • Useful for evaluating stenosis, aneurysm, thrombosis, or perivascular pathology

  • Myocardial late gadolinium enhancement shows infarcts in LAD territory (sulcus-related perfusion zone)

MRA (Magnetic Resonance Angiography):

  • Contrast-enhanced MRA depicts the LAD artery course within the sulcus

  • Demonstrates branching patterns, stenosis, occlusion, or anomalous vessel course

  • 3D reconstructions help correlate sulcus anatomy with perfusion territories

CT Appearance

Non-contrast CT:

  • Sulcus appears as a fat-filled groove on the anterior surface of the heart

  • Vessels (LAD, great cardiac vein) seen as tubular soft tissue structures; calcifications in LAD visualized as hyperdense foci

CT Coronary Angiography (CCTA):

  • Gold-standard modality for non-invasive visualization

  • Clearly shows LAD and great cardiac vein within the anterior interventricular sulcus

  • Detects plaques, stenosis, occlusion, or anomalies of the LAD

  • Multiplanar and 3D reconstructions outline the sulcus as a landmark for surgical planning and perfusion mapping

CT images

Anterior interventricular sulcus CT axial image -img-00000-00000

MRI image

Anterior interventricular sulcus mri axial image