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Раздел V

Вены сердца

Гл а в а 10 Вены сердца

Кровь, поступающая через коронарные артерии к миокарду, пройдя через капил­ лярную сеть, далее собирается в венулах и в последующем дренируется в вены сердца. В литературе крайне мало больших сообщений, касающихся описания вен сердца

В принципе существует две группы вен сердца: дренирующиеся в коронарный си­ нус и дренирующиеся в камеры сердца.

Вторая группа дренирует определенную часть крови, оттекающую от миокарда, минуя систему субэпикардиальных вен, прямо в полости сердца и известна как тебезиевы вены.

Вены, которые дренируют кровь в коронарный синус, располагаются параллельно венечным артериям.

Большая вена сердца выходит от верхушки вверх параллельно ПМЖВ и направля­ ется к атриовентрикулярной борозде, где принимает вены тупого края сердца (рис. 145). Она переходит в коронарный синус в задней атриовентрикулярной борозде.

До дренирования в правое предсердие коронарный синус принимает венозную кровь из средней вены сердца, которая располагается

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между трабекулами гребешковых мышц на дне ушка правого предсердия.

В камеры сердца дренируются и тебезиевы вены. Тебезиевы вены левого желу­ дочка дренируются в полость левого желудочка, а правого желудочка и межжелу­ дочковой перегородки - в полость правого желудочка (M.Ludinghausen, 1986;

М.Tschaibitcher, 1984).

Следует отметить, что анатомия вен сердца весьма вариабельна (рис. 147). Так, зад­ няя межжелудочковая (средняя) вена сердца впадает в коронарный синус в 87% случа­ ев. В 13% случаев она может прямо впадать в правое предсердие. Еще в 51% случаев вся венозная кровь из правого желудочка также может дренироваться в правое предсердие. Понимание этого факта очень важно в понимании случаев плохого охлаждения и защи­ ты миокарда правого желудочка при кардиоплегии. Так, согласно М. Liidinghausen (1986) и Е. Bezon (1997), в 64% случаев ретроградная кардиоплегия не в состоянии обес­ печить адекватную защиту миокарда правого желудочка. С точки зрения пространст­ венного расположения венозная система состоит из двух компонентов. Первый компо­ нент огибает сердце вдоль атриовентрикулярной борозды за исключением небольшого сегмента между правым предсердием и правым желудочком сердца.

Второй компонент состоит из вен, располагающихся продольно миокардиальной поверхности желудочков (Н. Uemura et ah, 1995).

В нормальном сердце чаще продольные вены соединяются с огибающим компо­ нентом (рис. 148). Исключение составляют короткие вены переднеправой поверх­ ности сердца.

Интересно, что при изомеризме ушек предсердий огибающий компонент венозной системы отсутствует (Н. Uemura et ah, 1995), а в сердцах с атриовентрикулярной дис-

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