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04 False Thebesian Veins -usu. True Vessels of Wearn

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    • 1957 posts
    May 27, 2014 7:29:50 PM PDT

    "Thebesian veins" that are not really "veins." This could get confusing.

    This webpage is one of many efforts to get cardiologists, anatomists, scientists, pediatricians, and everyone who studies anatomy to use the same words. If you dislike my idea, I am gratefully-acceptive of criticism. I alone cannot change hundreds of articles that refer to arteries as veins. However, if you choose, you can endorse disparate nomenclature. Much of medicine and healthcare is not decided by accuracy, but is determined by what is known as "clout." An excellent example of clout being essential to implementation of discovery into clinical practice is the discovery of the parathyroids. Their discovery was published, but lost in the medical literature for many years because the author didn't select the more influential medical journal to publish in. 

    If you are an author and you take offense at me suggesting we should rename the terms used in one of your articles, then I have already lost. My aim is for the scientific community, especially the medical community, to drastically simplify the nomenclature related to the "Thebesian veins." Perhaps you are an author and you scoff at my idea. Please share why. You may know that they are arteries, but it isn't necessary to go through a cardiology fellowship to realize that there is a venular side, and an arterial side. That there is a venae cardiacae minimae (Thebesian veins), and an arteriae cardiacae minimae (proposed; Vessels of Wearn). 

    Knowledge not only needs to be accesible to the elite, but to people that are not cardiologists. For example, 2 + 2 = 4 isn't a secret that should only be known by the elite. In fact most persons are familiar with that. Give the large number of publications using the term "Thebesian veins," or one of its synonyms to refer to the "vessels of Wearn," is evidence that their definition may be somewhat elusive and confusing, or simply inaccurate. What if half of text-books said 2+2 = 5; and the other half said 2+2=4. Students might become incredibly confused memorizing that fact, until they also learn how to solve addition problems. 

    In my humble opinion, the reason that people chose to use the term "Thebesian veins," to apply to these arterial connections, or #Vessels_of_Wearn, is secondary to lack of an appropriate name. If you want to call the vessels that you see radiographically something, you search for a term. With no appropriate, unambiguous term available, many authors probably selected a somewhat related term, the "vessels of Thebesius," also known as "Thebesian veins."

    This is an example of the proposed-now-inappropriate use of the term Thebesian veins: 

    http://www.ncbi.nlm.nih.gov/pubmed/11254857

    http://www.sciencedirect.com/science/article/pii/S1053077001938303

    Unexpected, transesophageal echocardiography-detected left ventricular microbubbles during off-pump coronary artery bypass graft surgery http://ow.ly/x3YoC
    TEE detection of microbubbles within the left ventricular cavity presented a diagnostic dilemma. Color-flow Doppler examination after placement of the TEE probe before surgical incision had failed to show any structural defects in the heart that would permit air entrainment in the left ventricle.

    On detection of left ventricular air, the surgeon was informed, and the surgeon's actions at the moment of air entrainment were reviewed. It was quickly discerned that at the time of the appearance of air in the left ventricle the surgeon was injecting saline down the left circumflex vein graft to test the anastomosis and to determine adequacy of graft patency and graft length. On repeated injection of warmed saline down the graft, air again appeared in the left ventricle. TEE also showed extensive microbubbles emanating from the coronary sinus. TEE examination of the aorta or native coronary vessels failed to reveal any microbubbles emanating from the coronary ostia in the aorta. It was concluded that air contained within the saline injection did not travel in a retrograde manner along the course of the native coronary vessels after graft injection. Microbubble production appeared to follow the course of the coronary vessels resulting in drainage through the thebesian system.

    The coronary sinus receives drainage from all cardiac veins except those of the thebesian system, which drain directly into the chambers of the heart.

    Thebesian veins are difficult to show, and their number and size are highly variable. They are numerous in the right atria and the right ventricle but can drain into the left ventricle as well, contributing to an anatomic shunt. Because no structural defects in the heart could be discerned and the authors could not show the presence of air within the aorta, it was concluded that air entrainment in the left ventricle occurred through the thebesian system.


    This post was edited by DrSocial Admin at April 7, 2015 3:22:57 PM PDT
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    • 1957 posts
    May 27, 2014 8:06:26 PM PDT

    Reading the original articles is a best practice. Vieussens did not discover Thebesian veins http://www.ncbi.nlm.nih.gov/m/pubmed/11241745/ pic.twitter.com/1swdcGOOzTAnatomy Thebesian veins histology


    This post was edited by DrSocial Admin at April 7, 2015 3:24:10 PM PDT
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    May 30, 2014 1:01:36 AM PDT

    This is a preliminary report of Wearn's findings, published in 1928 in the New England Journal of Medicine. Dr. Wearn was still using the terms "Thebesian," at this time. However, at his later

    Harvey lecture, things were not so.

    1812 — 1989 Archive Article: your archive account will be debited one view.

    PAPERS AND DISCUSSIONS

    The Thebesian Vessels of the Heart and Their Relation to Angina Pectoris and Coronary Thrombosis

    May 24, 1928 | WEARN , JOSEPH T. , M.D.†

    http://www.nejm.org/doi/full/10.1056/NEJM192805241981406vessels of Wearn


    This post was edited by DrSocial Admin at April 7, 2015 3:25:42 PM PDT
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    May 30, 2014 2:53:39 AM PDT

    Persistent thebesian veins presenting with myocardial ischemia

    Sudipta Chattopadhyay, MBBS MD MRCP,1 Nazneem Wahab, MD FRCPC,2 and Kenneth O’Reilly, MD FRCPC2
    This article has been cited by other articles in PMC.
     

    An 82-year-old man presenting with acute coronary syndrome (exercise-induced chest pain, ST-T wave changes and troponin I 0.21 μg/L) underwent coronary angiography. The left anterior descending artery (LAD) and right coronary artery (RCA) had minor nonobstructive plaque (Figures 1A and and1B).1B). Left coronary injection demonstrated a capillary blush draining into the left ventricular (LV) cavity due to multiple microfistulae (Figure 1C and Video) all along the wall of the left ventricle, extensive enough to produce an LV angiogram (Figure 1D). In the absence of any myocardial tumour, ventricular hypertrophy or evidence of noncompaction (on echocardiography), this appearance suggested arterioluminal-type thebesian veins communicating between the coronary arteries and LV cavity.

    Although arterioluminal thebesian veins have a larger diameter, a network extensive enough to produce LV opacification is rare. These veins bypass myocardial capillaries and may give rise to myocardial ischemia due to coronary steal (1), because the normal circulation offers a greater resistance to flow than the fistula. Extensive communication, as in the present patient, may lead to myocardial ischemia, severe enough to cause enzyme leak. This is due to a considerable decrease in intracoronary diastolic perfusion pressure that diminishes in proportion to the size of the fistula, especially during exercise. Anginal symptoms with ST segment changes due to myocardial hypoxia confirmed by elevated coronary sinus lactate levels has been demonstrated after atrial burst pacing in patients with multiple coronary artery-LV fistulae and normal epicardial coronary arteries (2).


    This post was edited by Brett Snodgrass at June 7, 2014 3:07:03 AM PDT
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    May 30, 2014 2:54:52 AM PDT

    January 1933, Vol 51, No. 1 >

    ARTICLE | January 1933
    NOURISHMENT OF THE MYOCARDIUM THROUGH THEBESIAN VESSELSIN A HEART IN WHICH THE LARGE CORONARY ARTERIES AND VEINS WERE DESTROYED BY TUBERCULOUS MYOCARDITIS
    SAMUEL BELLET, M.D.; B. A. GOULEY, M.D.; THOMAS M. McMILLAN, M.D.
    Arch Intern Med (Chic). 1933;51(1):112-121. doi:10.1001/archinte.1933.00150200115010.
    Submit a Comment
    NOURISHMENT OF THE MYOCARDIUM THROUGH (VESSELS OF WEARN).
    Posted on January 11, 2014
    Brett Snodgrass, MD
    Great Mines Health Center
    Conflict of Interest: None Declared
    Dear Reader, The connections described by Bellet et al. are not Thebesian veins as they connect a coronary artery to the heart chamber. They are consistent with the vessels of Wearn. http://bit.ly/JTWearnThe myocarditis may have resulted in angiogenesis and the neovascularization in this pathologic condition may be the etiology of the coronary-cameral connection.Comments and suggestions are welcome.Thank you kindly.
    -----------
    JAMA Network | JAMA Internal Medicine | NOURISHMENT OF THE MYOCARDIUM THROUGH THEBESIAN VESSELS:  IN A HEART IN WHICH THE LARGE CORONARY ARTERIES AND VEINS WERE DESTROYED BY TUBERCULOUS MYOCARDITIS http://archinte.jamanetwork.com/article.aspx?articleid=538697#.U4hT0k8GusY.twitter

    This post was edited by DrSocial Admin at April 7, 2015 3:27:04 PM PDT
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    June 8, 2014 1:14:01 AM PDT

    vessels of Wearn not Thebesian veins

     

    The article and Abstract are found here:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809485/

    A case of multiple coronary microfistulas to the left ventricle and apical myocardial hypertrophy coexisting with stable angina

    Abstract

    A coronary artery fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common congenital anomaly that can affect coronary perfusion. However, coronary fistulas to one of the cardiac chambers and coexisting apical myocardial hypertophy are infrequent anomalies, and usually are found unexpectedly. Herein, we report a case in which all three major coronary arteries emptied into the left ventricle with apical hypertrophy, through multiple microfistulas.

    Keywords: 

    A Case of coronary microfistula. Perhaps If the vessels of Wearn is going to be internationally adopted, and not merely in several peer-review articles, then these vessels would probably best be described as the #VasaWearn. I am interested in hearing a detailed, explanation that illustrates why they should not be so named. 


    This post was edited by DrSocial Admin at April 7, 2015 3:29:18 PM PDT
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    August 22, 2014 8:50:36 AM PDT

    This is not a Thebesian vein, it is an artery. 

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    • 1957 posts
    December 16, 2014 10:04:52 AM PST
    Here is another cardiology publication, publishd in 2013 that conflates arteries and veins, as is the custom and practice of most medical journals.

    It may be nice if the healthcare community made an effort to refer to arteries as arteries, and not as veins.
    Image 1 of 2
    This post was edited by Brett Snodgrass at December 16, 2014 10:06:58 AM PST
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    • 1957 posts
    December 16, 2014 10:12:14 AM PST
    What do you think can be done to get the world's medical community to star referring to as arteries as arteries instead of veins?

    Does it even matter? does it matter if we are explaining a disease to a patient, and then tell them that a Thebesian vein is actually the artery between their coronary artery and right ventricle?

    What if the patient decides to go to Wikipedia and reads that Thebesian veins are actually veins and not arteries? Will the patient have more trust in the doctor, or is there risk that they and everyone else will be more confused. The only people that can be guaranteed to thoroughly understand the topic will be a few cardiologists.

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