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Middle cardiac vein

The middle cardiac vein (MCV), also known as the posterior interventricular vein, is one of the major tributaries of the coronary sinus, which drains venous blood from the myocardium into the right atrium. The MCV begins near the apex of the heart, ascends in the posterior interventricular sulcus alongside the posterior interventricular artery (PDA, usually a branch of the right coronary artery), and empties into the coronary sinus near its termination at the right atrium.

The middle cardiac vein drains the posterior interventricular septum, portions of the posterior walls of both ventricles, and the apical region of the heart. Its anatomy makes it important in electrophysiological procedures, cardiac resynchronization therapy (CRT), and interventional cardiology, where coronary sinus access is essential.

Synonyms

  • Posterior interventricular vein

  • Vena cardiaca media

  • Coronary sinus tributary (posterior interventricular)

Function

  • Returns deoxygenated blood from the posterior interventricular septum and ventricles to the coronary sinus

  • Contributes to the cardiac venous drainage system, balancing myocardial oxygenation

  • Plays a role in procedural access for CRT leads, mapping, and ablation therapy

Tributaries

  • Small veins from the apex of the heart

  • Veins from the posterior interventricular septum

  • Veins from the posterior walls of right and left ventricles

MRI Appearance

T1-weighted images (non-contrast):

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

  • Vessel course visible as a thin hypointense line in the posterior interventricular sulcus

T2-weighted images:

  • Blood flow remains a signal void

  • Adjacent myocardium provides contrast; myocardial edema (e.g., infarction in PDA territory) appears hyperintense

MRI Non-Contrast Cardiac-Gated 3D Coronary Venography:

  • ECG-gated, respiratory-navigated acquisition

  • Middle cardiac vein visualized as a bright venous channel ascending the posterior interventricular sulcus

  • Demonstrates origin, course, tributaries, and drainage into the coronary sinus

  • Helpful for mapping venous anatomy pre-intervention

CT Appearance

Non-contrast CT:

  • Vein not well visualized without contrast, except as a faint soft tissue structure in the posterior interventricular sulcus

CT Coronary Angiography (CCTA – venous phase):

  • Clearly demonstrates the origin near the apex, course in posterior interventricular sulcus, and entry into coronary sinus

  • 3D reconstructions provide detailed mapping for CRT lead placement and venous interventions

  • Useful for evaluating venous anomalies, dilation, or obstruction

  • Can assess relation to adjacent coronary arteries (especially PDA)

CT image

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

MRI image

Middle cardiac vein mri image