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Posterior interventricular sulcus

The posterior interventricular sulcus is a prominent external groove of the heart located on its diaphragmatic (inferior) surface, running from the coronary sulcus toward the cardiac apex along the posterior aspect of the interventricular septum. It corresponds internally to the interventricular septum that separates the right and left ventricles.

This sulcus houses key vascular structures: the posterior interventricular artery (posterior descending artery, PDA) — usually a branch of the right coronary artery in right-dominant circulation — and the middle cardiac vein. These vessels run together within the sulcus, supplying and draining the posterior interventricular region of the heart.

The posterior interventricular sulcus is of great clinical importance as it serves as an anatomical landmark for the posterior descending artery in coronary angiography and bypass surgery. Its prominence and vascular contents vary with coronary dominance (right vs. left vs. co-dominant circulation).

Synonyms

  • Posterior interventricular groove

  • Inferior interventricular sulcus

  • Sulcus interventricularis posterior

Function

  • Marks the external division between the right and left ventricles on the diaphragmatic surface

  • Houses the posterior descending artery (PDA), which supplies the posterior septum and inferior ventricular walls

  • Contains the middle cardiac vein, which drains into the coronary sinus

  • Serves as a surgical and imaging landmark for coronary circulation and cardiac anatomy

Contents

  • Posterior interventricular artery (PDA) — branch of RCA (most common) or LCx (in left dominance)

  • Middle cardiac vein — drains posterior interventricular myocardium into coronary sinus

  • Fat and connective tissue surrounding these vessels

MRI Appearance

T1-weighted images:

  • Appears as a fat-containing groove between right and left ventricles

  • Vessels within the sulcus appear as signal voids (black lumen) surrounded by hyperintense fat

T2 Cine (Cardiac-gated):

  • Cine SSFP images show the sulcus as a landmark groove on the posterior surface

  • The PDA and middle cardiac vein appear as flow voids within the fat plane

  • Allows visualization of ventricular wall motion adjacent to the sulcus

STIR (Short Tau Inversion Recovery):

  • Fat suppression enhances visualization of vascular structures within the sulcus

  • Pathology such as myocardial edema, infarction, or perivascular inflammation in the PDA territory appears hyperintense

T1 Post-Contrast (Gadolinium-enhanced MRI):

  • PDA and middle cardiac vein enhance strongly with contrast

  • Late gadolinium enhancement of myocardium adjacent to the sulcus indicates posterior/inferior wall infarction

MRA (Magnetic Resonance Angiography):

  • Contrast-enhanced MRA demonstrates the course of PDA within the sulcus

  • Useful for assessing coronary dominance, stenosis, or anomalous course

CT Appearance

CT Coronary Angiography (CCTA):

  • Sulcus identified as a groove between right and left ventricles on posterior surface

  • PDA and middle cardiac vein visualized with contrast

  • Provides high-resolution images for stenosis, occlusion, dominance pattern, or anomalous origin

  • 3D reconstructions depict the sulcus and its vascular contents in relation to adjacent myocardium

CT images

Posterior interventricular sulcus anatomy CT axial image -img-00000-00000

CT images

Posterior interventricular sulcus anatomy CT axial image -img-00000-00000_00001

MRI image

Posterior interventricular sulcus mri image