By

Dr G. E. Ebito
At the end of this lecture, students are expected
to:-

 Describe the formation of primitive heart tubes.

 Discuss the cardiac looping.
 Mention the fate of each part of the PHT.
 Describe atrial & ventricular septation.
 Discuss the formation of valves & outflow tracts.
 Mention some common cardiac embryonic
anomalies.
 The heart is a muscular organ.
 Located in the middle mediastinum.
 Pumps blood through the circulatory system.
 By the end of gestational week 3, passive oxygen
diffusion becomes insufficient to support metabolism
of the developing embryo.
 Heart is the 1st organ to form during embryogenesis.
 In human embryos, heart begins to beat at abt 22-23
days, with blood flow beginning in the 4th wk.
 Heart & blood vessels are mesodermal in origin.
 The heart initially forms in the cranial-most end of the
embryo but later becomes ventral due to L/L foldings.
 Cardiogenesis begins with the formation of two
endocardial tubes which merge to form the tubular
heart called the primitive heart tube (PHT).
FORMATION OF THE HEART TUBE
 1st sign of heart devt is the
formatn of cardiogenic cords from
condensation of splanchnopleuric
mesoderm in the cardiogenic
region of the trilaminar germ disc.
 By D18-19, the cords canalize to
form 2 endocardial tubes.
 After head folding, the developing
heart tubes lie in the ventral
aspect of the embryo dorsal to the
developing pericardial sac.
 After lateral folding of the
embryo, the 2 heart tubes fuse
craniocaudally to form a single
endocardial heart tube within the
pericardial sac.
 The five regions of the primitive heart tube develop
into:-
 Truncus arteriosus: _ eventually divides to form
ascending aorta & pulmonary trunk.
 Bulbus cordis: _ develops into the right ventricle.
 Primitive ventricle: _ forms the left ventricle.
 Primitive atrium: _becomes the anterior portions of
both the right and left atria, and the two auricles.
 Sinus venosus: _ develops into the posterior
portion of the right atrium, the SA node and the
coronary sinus.
 Tubular heart tube
differentiates into:
 Truncus arteriosus
 Bulbus cordis
 Primitive ventricle
 Primitive atrium
 Sinus venosus.
Sinus Venosus
 The right horn forms
the smooth posterior
wall of the right
atrium.
 The left horn and body
atrophy and form the
coronary sinus.
 The left common
cardinal vein forms the
oblique vein of the left
atrium.
Each horn Cardinal vein
of the sinus
from the fetal
venosus
receives
body.
3 veins: Vitelline from
1.Common the yolk sac.
cardinal Umbilical
2.Vitelline from the
3.Umbilical placenta.
 Heart Tube Looping
 Degeneration of the central portion of the dorsal
mesocardium leaves the primitive heart attached at the
outflow and inflow ends.
 The heart grows rapidly, but it is still fixed at both ends
so it loops.
 As the heart tube develops, it bends upon itself such that

atrium and sinus venosus become dorsal to the truncus

arteriosus, bulbus cordis, and ventricle.
 By this stage the sinus venosus has developed 2 lateral
expansions, called the 2 horns ( right and left horns), and
body.
 The sinus venosus connects to the fetal circulation.
 Right Atrium
 Smooth posterior part is formed by right horn of
sinus venosus.
 Rough trabeculated anterior part is derived from
the primordial common atrium.
 These two parts are demarcated by the crista
terminalis internally and sulcus terminalis
externally.
 Left Atrium
 Almost entirely from common pulmonary vein,
only appendage from primitive atrium.
 Rough trabeculated part is derived from the
common primordial atrium.
 Smooth part is derived from the absorbed
pulmonary veins.
Left Atrium Development
Partitioning of Atrioventricular Canal
 Two endocardial
cushions are formed on
the dorsal and ventral
walls of the AV canal.

 The AV endocardial
cushions approach each
other and fuse to form
the septum
intermedium.
 Dividing the AV canal
into right & left canals.

 These canals partially

separate the primordial
atrium from the
primordial ventricle.
 Partitioning of Atrium
 Septum primum arises from the roof of atrial chamber
& grows downward towards the endocardial cushion,
separating primitive atrium into right & left halves.
 Foramen/ ostium primum is formed as a gap btw the
free end of septum primum & endocardial cushion, It
serves as a shunt, enabling the oxygenated blood to
pass from right to left atrium.
 Ostium primum becomes smaller and disappears as the
septum primum fuses completely with endocardial
cushions (septum intermedium) to form the interatrial
septum.
 Foramen/ ostium secundum forms as small openings
in the superior part of septum primum coalesce.
 Partitioning of Atrium
 Late 5th wk, septum secundum emerges to the right
of the septum primum & grows toward the
endocardial cushion & covers the foramen
secundum.
 Septum secundum is incomplete, leaving an opening
called foramen ovale.
 The upper part of septum primum regresses & the
remnant forms a flap valve for the foramen ovale.
 B4 birth, the foramen ovale lets most of the blood
entering the right atrium from the inferior vena cava
across to the left atrium.
 After birth, the foramen ovale fuses & the atrial
septum is complete.
Septum Secundum  The upper part of septum
primum that is attached
to the roof of the
common atrium shows
gradual resorption
forming an opening
called ostium secondum.

 Another septum descends

on the right side of the
septum primum called
septum secundum.
 It forms an incomplete
partition between the two
atria.
 Consequently a valvular
oval foramen forms,
called foramen ovale
Fate of foramen Ovale
 At birth when the lung
circulation begins the
pressure in the left atrium
increases and exceeds that of
the right atrium.
 So the two septae oppose
each other.
 Its site is represented by the
Fossa Ovalis.
 The septum primum forms
the floor of the fossa ovalis.
 The septum secondum
forms the margin of the
fossa ovalis called the
limbus (anulus) ovalis.
Partitioning of Primordial Ventricle
 Interventricular septum has
two parts – muscular &
membranous.
 Division of the primordial
ventricle is first indicated
by a median muscular ridge
(primordial interventricular
septum).
 By end of 4th wk, a
muscular septum grows
from the floor of primitive
ventricle towards the
fused endocardial cushions.
It is a thick crescentic fold
which has a concave upper
free edge.
Interventricular Septum
 Primordial
interventricular septum
is incomplete, having an
upper free gap called the
interventricular foramen,
which allows for
communication btw right
& left ventricles until ≈
end of 7th wk.
 The membranous part of
the IV septum is derived
from:
 A tissue extension from
the right side of the
endocardial cushion.
 Aorticopulmonary
septum.
 IF is filled by connective tissue from endocardial
cushions to form the membranous portion of
interventricular septum. This part fuses with conus
septum.
 The final closure of the interventricular septum is
coupled with the partitioning of the common
outflow tract.
 At closure of the interventricular septum, the
pulmonary trunk connects with the right ventricle
and the aorta with the left ventricle.
Spiral Aorticopulmonary Septum
A spiral septum
develops in the
truncus
arteriosus
dividing it into
aorta and
pulmonary trunk.

 The pulmonary
artery joins the
right ventricle.

 The aorta joins

the left ventricle.
 Subendocardial tissue in the bulbus cordis thickens
into 2 opposing ridges called truncoconal or bulbar
ridges.
 Semilunar ridges also form in the truncus
arteriosus and are continuous with those in the
bulbus cordis
 The bulbar ridges fuse with those of the truncus
arteriosus, with spiral orientation, to form
the aorticopulmonary septum, which definitively
separates the aorta and the pulmonary artery
 Bulbus cordis is incorporated into the walls of the
ventricles.
 Derivatives of bulbus cordis in adult, right ventricle
= conus arteriosus or infundibulum; and left
ventricle = aortic vestibule
BULBUS CORDIS
 The bulbus cordis
forms the smooth
upper part of the
two ventricles.
 In the right
Ventricle, it forms
the Conus
Arteriosus
(Infundibulum),
which leads to the
pulmonary trunk.
 In the left
ventricle, it forms
the aortic
vestibule, which
leads to the
aorta.
 Cardiogenic region - in splanchnic mesenchyme of
prechordal plate region.
 Week 2: pair of thin-walled tubes.
 Week 3: tubes fused, truncus arteriosus outflow, heart
contracting.
 Week 4: heart tube continues to elongate, curving to
form S shape.
 Week 5: Septation starts, atrial and ventricular.
 Septation continues, atrial septa remains open,
foramen ovale.
 Partitioning of the atria and ventricles is complete by
the end of the 5th wk, although fetal blood shunts
remain until birth.
 AV valves form btw 5th-8th wks, while semilunar valves
form btw 5th-9th wks.
 Week 40: At birth pressure difference closes foramen
ovale leaving a fossa ovalis.
 Patent foramen ovale
 ASD
 VSD
 Tetralogy of Fallot
 Patent ductus arteriosus
 Transposition of Great Arteries
Atrial Septal Defects
(ASD)
 Absence of
septum primum
and septum
secundum, leads
to a common
atrium.
 Absence of
Septum
Secundum
 Absence of
membranous
part of
interventricular
septum.
 Usually
accompanied
by other
cardiac
defects.
TETRALOGY OF FALLOT
 Fallot’s Tetralogy:

1-VSD.
2- Pulmonary
stenosis.
3-Overriding of the
aorta
4- Right ventricular
hypertrophy.
TRANSPOSITION OF GREAT ARTERIES (TGA)
 TGA is due to
abnormal rotation or
malformation of the
aorticopulmonary
septum.
 The right ventricle
joins the aorta, while
the left ventricle joins
the pulmonary artery.
 One of the most
common causes of
cyanotic heart disease
in the newborn.
 Often associated with
ASD or VSD.
 Persistent Truncus Arteriosus
 Itis due to failure of the development of the
aorticopulmonary (spiral) septum.
 Usually accompanied with VSD.