Smallest cardiac veins contribute to normal physiologic shunting of blood. As a consequence of the input of these vessels, blood in the left heart is less oxygenated than the blood found at the pulmonary capillary beds, albeit to a very small degree. The "openings of smallest cardiac veins" are located in the endocardium. Here the smallest cardiac veins return blood into the heart chambers from the capillary bed in the muscular cardiac wall, enabling a form of collateral circulation unique to the heart. Not every endocardial opening connects to the thebesian veins as some connect to the vessels of Wearn, which are arteries.
Vascular remodelling in the embryo to the venous network, effectively changing their identity. This is thought to be due to the high luminal pressure in the arterial lines, which prevents reattachment of the branches back onto arterial vessels. This also prevents the formation of shunts between the two components of the network. Researchers have verified this identity-switching phenomenon by successfully grafting sections of quail endothelial tubing which had previously expressed arterial markers onto chick veins (or vice versa), showcasing the plasticity of the system. Reversing flow patterns in arteries and/or veins can also have the same effect, although it is unclear whether this is due