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Case Reports
. 2019 Dec 5;21(4):127-129.
doi: 10.1016/j.jccase.2019.11.007. eCollection 2020 Apr.

Prominent Thebesian veins, a rare congenital coronary anomaly presenting as acute myocardial ischemia

Seong Geun Kim  1 , Hyoeun Kim  2 , Sung Woo Cho  1 , Byung Gyu Kim  1
Affiliations
Case Reports

Prominent Thebesian veins, a rare congenital coronary anomaly presenting as acute myocardial ischemia

Seong Geun Kim et al. J Cardiol Cases. .

Abstract

Persistent Thebesian veins with the appearance of multiple coronary artery microfistulas are a rare finding and little is known about their physiologic and clinical features. In addition, few reports have demonstrated the perfusion status of patients with Thebesian veins. We report a 75-year-old woman referred for non-ST-elevation myocardial infarction due to prominent Thebesian veins who displayed a perfusion defect in cardiac magnetic resonance imaging. <Learning objective: This case emphasizes that non-obstructive coronary arterial anomaly can lead to myocardial ischemia with angina symptoms and cardiac enzyme rise. Moreover, it provided the typical angiographic appearance of Thebesian vein network and image of myocardial perfusion defect induced by coronary steal.>.

Keywords: Acute myocardial infarction; Cardiac magnetic resonance imaging; Thebesian veins.

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Figures

Fig. 1
Fig. 1
Twelve-lead electrocardiography showing left ventricular hypertrophy with a T-wave inversion on lead V3-6.
Fig. 2
Fig. 2
Coronary angiography showing no significant stenosis. Abnormal contrast blush with drainage into the left ventricular chamber can be observed on both coronary arteries, left (A and B) and right (C and D). Arrows point to the contrast blush through the Thebesian venous network, allowing the visualization of the endocardial border (B and D).
Fig. 3
Fig. 3
Cardiac magnetic resonance imaging of perfusion sequence (A and B) and late gadolinium enhancement imaging sequence (C). The yellow arrows point to a subendocardial ring of low signal enhancement, showing the perfusion defect in the subendocardium from the base (A) to mid-left ventricle (B). No late gadolinium enhancement was seen at a delayed phase (C).
See this image and copyright information in PMC

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