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Topic

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Great cardiac vein

The great cardiac vein (GCV), also called the anterior interventricular vein, is the largest tributary of the coronary sinus. It begins near the apex of the heart in the anterior interventricular sulcus, accompanying the left anterior descending artery (LAD). It ascends within the sulcus toward the coronary sulcus, then curves left around the heart, continuing into the coronary sinus.

The great cardiac vein primarily drains the anterior wall of the left ventricle, the anterior interventricular septum, and the cardiac apex. Along its course, it receives tributaries from the anterior interventricular veins, left marginal vein, and left atrial veins.

The GCV is of major clinical importance in cardiac venous mapping, electrophysiology procedures, biventricular pacing (CRT), and coronary venous interventions.

Synonyms

  • GCV

  • Anterior interventricular vein

  • Vena cardiaca magna

Function

  • Drains oxygen-depleted blood from the anterior left ventricle, interventricular septum, and apex

  • Empties into the coronary sinus, which drains into the right atrium

  • Provides an important venous access route for cardiac resynchronization therapy (CRT) and electrophysiological procedures

  • Serves as a landmark in coronary venous anatomy

Tributaries

  • Anterior interventricular veins (accompanying LAD)

  • Left marginal vein (drains lateral LV wall)

  • Left atrial veins

  • Small tributaries from the anterior LV surface

MRI Appearance

T1-weighted images:

  • Flowing venous blood appears as a signal void (black lumen)

  • Vessel wall hypointense; adjacent fat helps localization

T2-weighted images:

  • Lumen remains a signal void

  • Dilatation, thrombus, or slow flow may alter signal intensity

  • Perivascular edema appears hyperintense

STIR (Short Tau Inversion Recovery):

  • Fat suppression improves visualization of venous margins in pericardial fat

  • Pathology (e.g., thrombosis, inflammation) appears bright hyperintense

MRA (Magnetic Resonance Angiography):

  • Contrast-enhanced MRA provides clear depiction of course, tributaries, and connection to coronary sinus

  • Useful for congenital anomalies, venous stenosis, or CRT lead placement planning

CT Appearance

Non-contrast CT:

  • Great cardiac vein appears as a tubular soft tissue density structure adjacent to LAD in anterior interventricular sulcus

  • Limited visualization without contrast

CT Coronary Venography (CCTA – venous phase):

  • Provides high-resolution depiction of origin, course, tributaries, and drainage into coronary sinus

  • Detects venous anomalies, stenosis, thrombosis, or dilatation

  • Crucial for CRT lead planning, venous access procedures, and electrophysiology mapping

  • 3D reconstructions demonstrate detailed coronary venous anatomy

MRI image

Great cardiac vein mri axial image

CT image

Great cardiac vein CT axial image -img-00000-00000