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Posterior vein of left ventricle

The posterior vein of the left ventricle (PVLV) is an important tributary of the coronary venous system, draining the posterior wall of the left ventricle. It typically arises from venous channels on the diaphragmatic (posterior) surface of the left ventricle and ascends along the posterior interventricular groove or nearby myocardial surface.

The PVLV usually empties into the coronary sinus, although in some individuals it may join the great cardiac vein before reaching the coronary sinus. It plays a major role in draining venous blood from the diaphragmatic surface of the left ventricle, contributing to the overall return of deoxygenated blood to the right atrium.

Anatomical variations are frequent: it may be single, multiple, or form part of a venous plexus. Its recognition is important in cardiac resynchronization therapy (CRT), left ventricular lead placement, and interventional cardiology, where coronary venous access is required.

Synonyms

  • PVLV

  • Posterior left ventricular vein

  • Left ventricular posterior vein

  • Coronary sinus tributary (posterior LV)

Function

  • Drains deoxygenated blood from the posterior wall of the left ventricle

  • Returns blood to the coronary sinus, which empties into the right atrium

  • Contributes to cardiac venous return balance

  • Serves as a potential access route for LV pacing leads in CRT

Tributaries

  • Venous branches from the posterior and diaphragmatic surface of the left ventricle

  • May receive collateral connections from adjacent posterior interventricular and lateral cardiac veins

MRI Appearance

T1-weighted images (non-contrast):

  • PVLV lumen appears as a signal void (black) due to venous flow

  • Course defined by surrounding epicardial fat in posterior LV region

T2-weighted images:

  • Flow void persists in lumen

  • Perivascular edema or adjacent pathology (e.g., infarct in posterior wall) may appear hyperintense

T1 Post-Contrast (Gadolinium-enhanced):

  • PVLV enhances brightly and homogeneously, especially on venous phase imaging

  • Helps delineate its connection to the coronary sinus

  • Useful for mapping venous anatomy in CRT candidates

MRI Non-Contrast Cardiac-Gated 3D Coronary Venous Imaging:

  • Cardiac-gated 3D whole-heart MRA can visualize PVLV as a continuous enhancing venous channel draining into coronary sinus

  • Helpful for non-invasive evaluation of venous anatomy prior to CRT

CT Appearance

Non-contrast CT:

  • PVLV is difficult to identify without contrast

  • Occasionally visible as a small tubular structure in posterior LV epicardial fat

CT Coronary Venous Angiography (CCTA):

  • Provides high-resolution visualization of PVLV, its tributaries, and termination into coronary sinus

  • Excellent for mapping coronary venous anatomy prior to CRT lead placement

  • Identifies anatomical variations, venous stenosis, or tortuosity

  • Multiplanar and 3D reconstructions demonstrate its relationship with adjacent coronary arteries and myocardium

MRI image

Posterior vein of left ventricle mri axial

CT images

Posterior vein of left ventricle CT axial image -img-00000-00000

CT images

Posterior vein of left ventricle CT axial image -img-00000-00000_00001