"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:
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 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.†
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).
The article and Abstract are found here:
A case of multiple coronary microfistulas to the left ventricle and apical myocardial hypertrophy coexisting with stable angina
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.
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.
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