CARDIOVASCULAR

CARDIOVASCULAR - EMBRYOLOGY (First AID 2020)

HEART MORPHOGENESIS

Heart:
First functional organ in vertebrate embryos;
beats spontaneously by week 4 of development.

CARDIAC LOOPING
Primary heart tube loops to establish left-right polarity;
Begins in week 4 of development.

Kartagener syndrome (1° ciliary Dyskinesia)

Defect in left-right Dynein (involved in L/R asymmetry) can lead to Dextrocardia

1
SEPTATION - CHAMBERS

ATRIA

(1) Septum primum grows toward endocardial cushions, narrowing foramen primum.

(2) Foramen secundum forms in septum primum (foramen primum disappears).

(3) Septum secundum develops as foramen secundum maintains right-to-left shunt.
(4) Septum secundum expands and covers most of the foramen secundum.
The residual foramen is the foramen ovale.

(5) Remaining portion of septum primum forms valve of foramen ovale.

6. Septum primum closes against septum secundum, sealing the foramen ovale soon after birth
because of LA pressure and RA pressure.
7. Septum secundum and septum primum fuse during infancy/early childhood, forming the atrial
septum.

Patent Foramen Ovale

Caused by failure of septum primum and septum secundum to fuse after birth;
Most are left untreated.
Can lead to paradoxical emboli (venous thromboemboli that enter systemic arterial
circulation), similar to those resulting from an ASD.

2
VENTRICLES

(1) Muscular interventricular septum forms.

Opening is called interventricular foramen.

(2) Aortico Pulmonary septum rotates and fuses with muscular ventricular septum to form
membranous interventricular septum, closing interventricular foramen.

(3) Growth of endocardial cushions separates atria from ventricles and contributes to both
atrial septation and membranous portion of the interventricular septum.

VSD
MC congenital cardiac anomaly
Usually occurs in membranous septum

OUTFLOW TRACT FORMATION

Neural crest and endocardial cell migrations

Truncal and bulbar ridges that spiral and fuse to form aorticopulmonary septum
Ascending aorta and pulmonary trunk.

Conotruncal abnormalities associated with failure of neural crest cells to migrate:

Transposition of great vessels
TOF
Persistent truncus arteriosus

VALVE DEVELOPMENT

Aortic/pulmonary: Derived from endocardial cushions of outflow tract.

Mitral/tricuspid: Derived from fused endocardial cushions of the AV canal.

Valvular anomalies may be stenotic, regurgitant, atretic (eg, tricuspid atresia), or displaced
(eg, Ebstein anomaly).
3
HEART EMBRYOLOGY

EMBRYONIC STRUCTURE GIVES RISE TO

Truncus Arteriosus Ascending aorta and pulmonary trunk
Bulbus Cordis Smooth parts (outflow tract) of both ventricles

Primitive Ventricle Trabeculated part of both ventricles

Primitive Atrium Trabeculated part of both atria

Sinus Venosus (Lt Horn) Coronary sinus

Sinus Venosus (Rt Horn) Smooth part of Rt atrium (sinus venarum)

Endocardial Cushion Atrial septum

Membranous IV septum
AV and semilunar valves

Rt Common Cardinal Vein Superior vena cava (SVC)

Rt Anterior Cardinal Vein

Posterior Inferior vena cava (IVC)

Sub Cardinal
Supra Cardinal Veins

Primitive Pulmonary Vein Smooth part of Lt atrium

4
FETAL CIRCULATION

Blood in umbilical vein

PO2 of mm Hg
saturated with O2
Umbilical arteries have low O2 saturation.

3 Important shunts:
(1) Blood entering fetus through the umbilical vein is conducted via the ductus venosus into the
IVC, bypassing hepatic circulation.

(2) Most of the highly Oxygenated blood reaching the heart via the IVC is directed through the
foramen Ovale into LA.

(3) Deoxygenated blood from the SVC passes through RA

RV
Main pulmonary artery
Ductus arteriosus
Descending aorta.

Shunt is due to high fetal pulmonary artery resistance (due partly to low O 2 tension).

At birth, infant takes a breath

Resistance in pulmonary vasculature

Left atrial pressure vs right atrial pressure

Foramen ovale closes (now called fossa ovalis);

O2 (from respiration)
Prostaglandins (from placental separation)

Closure of ductus arteriosus.

Indomethacin helps close PDA Ligamentum arteriosum (remnant of ductus arteriosus).

Come In and Close the Door.

Prostaglandins E1 and E2 kEEp PDA open.

5
Prosta Cyclin
PGI2 Platelet aggregation Epoprostenol
Vascular tone
Prosta Glandin
PGE1 Vascular tone Alprostadil
PGE2 Uterine Tone Dinoprostone
PGF2 Uterine tone Carboprost
Thromboxane
TXA2 Platelet aggregation
Vascular tone

6
FETAL POST NATAL DERIVATIVES

FETAL STRUCTURE POST NATAL DERIVATIVE NOTES

Allantois urachus Median umbilical ligament Urachus is part of allantoic duct
between bladder & umbilicus.
Ductus arteriosus Ligamentum arteriosum Near left recurrent laryngeal
Ductus venosus Ligamentum venosum
Foramen ovale Fossa ovalis
Notochord Nucleus pulposus
Umbilical arteries Medial umbilical ligaments
Umbilical vein Ligamentum teres hepatis Contained in falciform ligament.
(round ligament)