Hemodynamic significance of the coronary vein valves.

ABSTRACT

The incidence and morphology of one-way coronary vein valves were studied, together with their influence on the administration of retrograde cardioplegia. Calf, juvenile pig, and adult mongrel canine hearts (12 each) and human cadaver hearts (five adult and seven pediatric) were dissected. The pressure gradients between the coronary sinus and the posterior vein of the left ventricle were measured in 21 hearts during the retrograde administration of fluid. Species differences were noted, with apparently competent valves seen more frequently in calf hearts (mean, 1.33 valves +/- 0.22 [SEM] per heart) than in pig hearts (mean, 0.83 +/- 0.17 [SEM] per heart). In humans, more valves were seen in pediatric hearts (five valves in seven hearts) than in adult hearts (one valve in five hearts). No competent valves were found in dog hearts (chi 2 analysis; p < 0.0001). In calf hearts, a pressure gradient of 5 to 35.5 mm Hg was required before the valve opened. In pig hearts, these opening pressure gradients ranged from 0 to 19.5 mm Hg. The distribution of retrograde cardioplegia may be impaired in the presence of competent valves, particularly when low coronary sinus pressures are used.