Basic Cardiac Embryology &

Fetal Circulation

Timeline of Events

Week 3 (21 days) - heart tube forms

23 days- heart beats
Week 4 - cardiac loop forms
Week 7 - heart fully developed
the 1st organ to fully develop in the fetus
resembles adult heart except for foramen
ovale

approx. 3wks
Heart tube

approx. 4 wks
cardiac loop forms

approx. 7 wks
fully developed

Primitive Cardiac Tube

(bulboventricular tube)

Consists of 6 parts
functioning as a
tubular pump:

sinus venosus
primitive atria
primitive ventricle
bulbus cordis
conus cordis
truncus arteriosus

Cardiac Loop

As the tube grows it

bends in an anterior
& rightward direction
forming the
bulboventricular loop.
Normal looping =
dextro or d-looping
Abn. looping to left =
levo or l-looping

What forms what

Sinus venosus (1)

Primitive atria (2)
1 & 2 contribute to SVC, IVC, CS, RA & LA

Atrioventricular canal (3)

large area of connection between primitive
atria & ventricle
endocardial cushion will form here; will form
parts of MV & TV

More...

Primitive ventricle (4) - forms into LV

Bulbus cordis: 3 parts
Primitive RV (5)
Conus cordis (6) - will form the ventricular
outflow tracts (crista supraventricularis)
Truncus arteriosus (7) - will form the aorta
& pulmonary artery trunk

Aortic arches

6 paired sets of arches form about week 4

These develop into the adult arterial
system
3rd set forms common & internal carotid
arteries bilaterally
4th develops into aortic arch
6th develops into right & left pulmonary
arteries & ductus arteriosus

Septation
(septal development)

Atrial septum:
Atrial septum begins from the atrial roof;
septum primum & septum secundum
separate common atria into rt & lt halves

Endocardial cushions:
divide the AV canal into 2 orifices & parts of
MV & TV; help form part of the atrial primum
septum & membranous ventricular septum

Valves

AV valves (mitral & tricuspid) are formed

mainly from the internal ventricular
muscular wall
Aortic & pulmonic roots are formed from
a separation that occurs in the truncus
arteriosus. The semilunar valves are
formed from small tubercles in the
truncus.

Fetal circulation (prenatal)

In the adult, the lungs provide oxygen

and CO2 exchange
In the fetus, the lungs are basically
collapsed & fluid-filled so there is high
resistance to blood flow
The placenta provides oxygen for the
fetus;delivers nutrients & removes
wastes

Fetal

Right-sided pressure
higher
Higher pulmonary
resistance
3 shunts exist
Placenta provides
oxygenated blood
IVC blood is O2 rich
SVC,CS is O2 poor

Post-natal

Lungs inflate; lowers

pulm resistance/ Rt-heart
pressures
Lt-heart press. rises;
closes foramen ovale
Ductus arteriosus closes
w/in 48-72 hrs; becomes
ligamentum
Ductus venosus closes
as flow ceases; becomes
ligamentum

Changes at birth

When newborn begins to breathe, the

babys body gets higher levels of O2
Pulmonary vascular resistance
decreases, blood flow into the lungs
increases
LAP rises; closes foramen ovale
Increases O2 levels, lower vascular
resistance closes ductus arteriosus

Continued..

Clamping umbilical cord ends placental

function; closes umbilical vein & ductus
arteriosus

In premature infants, PFO & PDA are

common

Key to diagram
1. Aortic arch

11. Portal sinus

2. Ductus arteriosus

12. Portal vein

3. Pulmonary trunk

13. Umbilical vein

4. Pulmonary veins

14. Umbilical arteries

5. LA

15. Placenta

6. SVC

16. Descending aorta

7. Foramen ovale
8. RA
9. IVC
10. Ductus venosus

Sources

CV Principles: A Registry Prep, Reynolds

Echocardiography, 2nd edition, Allen
Textbook of Diagnostic Ultrasound, 5th
edition, Hagan-Ansert
DeWitt
Feigenbaums Echocardiography, 6th
edition.