30-11-2023

Development of CVS

Dr. Bhavana

Explain developmental basis of tracheo-esophageal

fistula

 What is tracheo-esophageal fistula?

 Types
 Clinical features
 Normal development and separation
of trachea & esophagus
 Developmental basis of tracheo-
esophageal fistula with or without
esophageal atresia

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Competencies

AN25.2 Describe development of pleura, lung & heart

AN25.4 Describe embryological basis of:
1) atrial septal defect, 2) ventricular septal defect,
3) Fallot’s tetralogy &
4) tracheo-oesophageal fistula

Contents

Heart
Arteries
Veins
Circulation before and after birth

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Heart

 From – Splanchnopleuric
mesoderm of cardiogenic
area, ventral to future
pericardium – part of
intraembryonic coelom
 As 2 endothelial heart
tubes

Heart

With cranial folding –

 Forebrain overhangs
developing heart
 Heart moves to ventral surface
of the embryo
 Pericardial cavity lies ventral
to heart

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Heart tube

2 heart tubes fuse – single

tube
Series of dilatations –
Craniocaudally –
 Bulbus cordis
 Primitive ventricle
 Primitive atrium
 Sinus venosus

Heart tube

2 heart tubes fuse – single

tube
Series of dilatations –
Craniocaudally –
 Bulbus cordis
 Primitive ventricle
 Primitive atrium
 Sinus venosus

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Heart tube
 2 tubes remain separate caudally
– 2 horns of sinus venosus
 Sinus venosus – venous end of
the heart
 Each horn receives – 1 of each
– common cardinal, vitelline and
umbilical veins
 Narrow atrioventricular canal
connects primitive ventricles and
atria

Bulbus cordis

Has 3 parts
Craniocaudally –
 Truncus arteriosus – arterial end
of the heart
 Conus
 Proximal 1/3rd

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Formation of
cardiac loop
Day 23 to 28
 Due to faster growth of
bulbus and ventricle the
heart tube bends
 Bulbus goes ventral, caudal
and to the right – a U shaped
bulboventricular loop
 Proximal 1/3rd and conus
come to lie to the right of
primitive ventricle

Formation of
cardiac loop
 Atrium and sinus become
free from septum
transversum and go dorsal,
cranial and to the left – a S
shaped loop
 Atrium comes to lie
behind truncus
 Atrium expands and partly
project anteriorly on each
side of truncus

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Competencies
AN25.2 Describe development of pleura, lung & heart
at the end of the session the phase I student
shall be able to
25.2.1 Mention source of development of heart
25.2.2 List relevant changes with folding of embryo
25.2.3 Specify development of heart tube – formation,
list of dilatations
25.2.4 Specify parts and development of bulbus cordis
25.2.5 Explain folding of heart tube with its effects

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Development of atria

 From – sinus venosus, primitive

atrium
 Sinus venosus and primitive
atrium connected by wide
sinuatrial opening
 Left groove separating sinus from
atrium on outside deepens
 Left horn narrows due to left to
right shunts in venous system

Development of atria

 Sinu atrial opening shifts to

right on posterior wall and
becomes narrow vertical slit
with 2 borders called left and
right venous valves
 Sinus becomes part of right
atrium
 Left horn looks like a tributary
of right horn

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Development of
atria
 Sinu atrial opening shifts to
right on posterior wall and
becomes narrow vertical slit
with 2 borders called left and
right venous valves
 Sinus gets absorbed in to &
becomes part of right atrium
 Left horn looks like a tributary
of right horn

Development of
atria
 Sinu atrial opening shifts to
right on posterior wall and
becomes narrow vertical slit
with 2 borders called left and
right venous valves
 Sinus gets absorbed in to &
becomes part of right atrium
 Left horn looks like a tributary
of right horn

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Fate of venous
valves
 Left valve – fuses with septum
secundum – part of interatrial
septum
 Right valve – enlarges and is
divided in 3 parts by 2 limbic bands
(superior & inferior)
Upper part – crista terminalis
Middle part – valve of IVC
Lower part – valve of coronary
sinus

Atrioventricular cushions

 End of 4th week

 2 atrioventricular cushions
develop on anterior and
posterior walls of
atrioventricular canal.
 They fuse – septum
intermedium
 Separate right and left
atrioventricular canals

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Atrioventricular cushions

 2 atrioventricular
cushions fuse –
septum intermedium
 Separate right and
left atrioventricular
canals

Interatrial septum

 End of 4th week

 Primitive atrium is divided into right
and left by development of 2 septa
 A thin septum arises from roof of
primitive atrium – septum primum
Left to the cranial fused portion
of left and right venous valves –
septum spurium

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Septum primum
 Grows downwards
towards septum
intermedium
 Gap between 2 –
foramen primum
 2 fuse

Septum primum
 Upper part of septum
primum breaks down –
foramen secundum
 Foramina ensure oxygenated
blood gets shunted from
right atrium to left

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Septum secundum

 A new thick septum arises

from roof of primitive
atrium – septum secundum
 Right to the septum
primum
 Grows downwards
 Overlaps septum primum

Septum secundum

 Never meets septum

intermedium
 Has lower free border – crista
dividens
 Blood flows to left from
under septum secundum –
between septum primum &
secundum – through
foramen secundum
 Valvular passage – foramen
ovale

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Fate after birth

 Left atrial pressure increases

– blood from pulmonary veins
 Right atrial pressure drops –
no more blood from umbilical
vein
 Flap like septum primum
closes over septum secundum
 Foramen ovale closes
 Complete fusion by 3
months

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Remnants after birth

 Septum primum – fossa

ovalis
 Crista dividens – limbus
fossa ovalis
 25% people have probe
patent foramen ovale – a
probe can be passed. By itself
clinically insignificant

Development of right atrium

 Rough anterior part + right

auricle – primitive atrium
 Smooth sinus venarum –
absorbed sinus venosus
 Also right half of
atrioventricular canal

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Tributaries of
right atrium

As sinus gets absorbed in right

atrium
 Left horn – very small – part of
coronary sinus
 Right common cardinal vein –
part of superior vena cava
 Right vitelline vein – part of
inferior vena cava
 As sinus is absorbed – these 3
look like veins opening in right
atrium

Development of left atrium

 Rough part + left

auricle – primitive
atrium
 Smooth part – absorbed
proximal parts of
pulmonary veins
 Also left half of
atrioventricular canal

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Atrial septal defect

 ASD
 ♀>♂
 25% – Probe patent
 Most common – ostium
secundum defect
 Either septum primum excess
resorption or defective septum
secundum or both

Atrial septal defect

 ♀ : ♂ = 3:1
 > 2cm – significant
 Tolerated by children
 Left to right shunt
 Right ventricular overload
 Pulmonary hypertension
after 30 years
 ℞ – by surgery

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As defects

Less common –
 Endocardial cushion &
foramen primum defect –
common in Down syndrome
 Sinus venosus AS defect –
near SVC – incomplete
absorption of sinus
 Common atrium – absent
septum

Competencies
AN25.2 Describe development of pleura, lung &
heart
at the end of the session the phase I student
shall be able to
25.2.1 Specify development of interatrial septum
25.2.2 List remnants of interatrial septum
25.2.3 Specify development of right and left atria
25.2.4 Explain parts, tributaries & fate of sinus
venosus
25.2.5 Mention fate of venous valves

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Competencies

AN25.4 Describe embryological basis of:

1) atrial septal defect, 2) ventricular septal
defect, 3) Fallot’s tetralogy &
4) tracheo-oesophageal fistula
at the end of the session the phase I student
shall be able to
25.4.1 Explain embryological basis of development &
features atrial septal defects

Questions for next time

1. List structures contributing to development of interatrial septum. Write
its anyone anomaly – BAQ
2. Specify development of interatrial septum with it’s any one anomaly –
SAQ
3. List structures contributing to development of right atrium. Write its
anyone anomaly – BAQ
4. Specify development of right atrium with it’s any one anomaly – SAQ

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BYE !!

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