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DEVELOPMENTAL ANATOMY
Cardiovascular S Cardiovascular Systemystem
Dr. Sukumal Chongthammakun Department of Anatomy, Faculty of Science
Mahidol University
http://intranet.sc.mahidol/AN
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Development of Blood Vessels
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Development of Blood VesselsLocation: Body, ConnectingStalk, Yol k Sac, Chor i on
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Mesenchymal cells (Splanchnic mesoderm)
Development of Cardiogenic Area
Angiogenic clusters• plexus of small blood vessels• ant. portion = cardiogenic area
3Late presomite embryo ( rd week)
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Development of cardiogenic area and pericardial cavity
18 days
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Development of cardiogenic area and pericardial cavity
intraembryonic coelom = pericardial cavity
18 days
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• Head Flexion• Rotation of cardiogenic area
- caudal to prochordal plate
- dorsal to septum transversum(diaphragm) & intraembryonic coelom (pericardial cavity)
Fusion of the Heart Tubes
•Fusion of paired tubes
single tube
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Rotation of cardiogenic area & pericardial cavity
180o rotation along a transverse axis
19-20 days
22 days
21 days
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Formation of a single heart tube
early presomite embryo (1 7 days)
late presomite embryo ddddd18
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Formation of a single heart tube
ddd ddddd2 1 ( 4 )• dddddd dd ddddddddddd ddddd
22 8days (at somites)• dddddd ddddddddddd dddd
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Formation of Myoepicardial Mantle
• Splanchnic mesoderm surrounds the heart
• Cardiac jelly (extracellular matrix)- rich in collagen & glycoproteins- play role in cardiac morphogenesis
Myoepicardial Mantle
• Myocardium• Epicardium
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21 days 22 days
Atrium is the last to fuse. Sinus horns are embedded in the septum transversum.
Formation of a single heart tube
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Subdivisions of the Primitive Heart(26 days)
• Lt. & Rt. Aortic arches• Aortic root• Truncus arteriosus• Bul bus cor di s• Ventricle• Atrium• Lt. & Rt. horns of Sinus venosus
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Formation of the Cardiac Loop
1 . Bulbus cordis bends in ventral & cau dal & to the right.
2 . Atrium shifts in a dorsal & cranial direction.
3. Bulboventricular sulcus is created.
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Formation of the Cardiac Loop• - U shaped & convexed forward and to the right• Ventricular growth• - S shaped & bulboventricular sulcus in concaved loop
23 days (11 )
22 days 8( somites)
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Formation of the Cardiac Loop
24 days 16( somites)
• Primitive atrium moves up into the pericardial cavity
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Formation of the Cardiac Loop
28 days
• Atrium grows dorsally to the left• Ventricle & bulbus cordis grows ventrally & to the right
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Formation of the Cardiac Loop
1. Common atrium incorporated into pericardial cavity.
2. Atrioventricular canal is narrowed.
3 . ,Bulbus cordis is narrowed except trabeculated part of right ventricle.
4. Conus cordis will form outflow tracts of ventricles.
5 . Truncus cordis will form roots of aorta & pulmo ddddddd.
6 . Bulboventricular sulcus = primary interventricu ddddd ddd.
28days
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30 days
At the end of the loop formation
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Septum Formation in Common Atrium
1. Endocardial cushions are formed in the AV canal. 2. Septum primum grows from the roof of common atrium. 3. Foramen (Ostium) primum is formed.
4. Perforation appears in septum primum.
30 days(6 mm.)
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Septum Formation in Common Atrium33 days(9 mm.)
1. Endocardial cushion extends to close Foramen prim.
2. Foramen (Ostium) secundum is formed. 3. Fusion of endocardial cushions.
4. Septum secundum grows downward/toward endocard ial cushion. 5. Foramen ovale is remained on the inf. border of Sept
dddddddd d.
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Septum Formation in Common Atrium
37 days(14 mm.)
Newborn
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Septum Formation in Common Atrium
1. Septum secundum is never completed.
2. Left venous & septum spurium fuse wi th septum secundum
3. Oval foramen is formed.
4 . =Septum primum valve of oval foramen.
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Differentiation of Atria
1. Right sinus horn incorporates into right atriald ddd = smooth wall of right atrium = sinus venarum
2. Pulmonary vein develops as outgrowth of leftdddddd d ddd dd dddd d ddd dd dddd dddddd=
35 days (7- to 8- mm) Newborn
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Development of Venous Valves
35 days (7- to 8- mm) 1. Septum spurium = fusion of Rt. & Lt. venous v
alves. 2. Sup. portion of Rt. venous valve disappears. 3. Inf. portion of Rt. venous valve = valve of IVC
& valve of coronary sinus 4. Crista terminalis = dividing line
Newborn
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Changes in Sinus Venosus
35 days 1. The veins to left sinus horn degenerates. 2. Right sinus horn moves to the right side.
8 week 1. Left sinus horn becomes dddddddd dddd
d & obl i que vei n of the left atrium. 2. Right sinus horn incorporates into the w
all of left atrium. 3. Sinuatrial orifice shifts to the right and is
bordered by right & left venous valves (Sept ) .
• Left venous valves : fuse with atrial septud• Right venous valves : Valve of IVC & Valve
of Coronary sinus
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Development of Sinus Venosus
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Development of Sinus Venosus
The remains of left sinus horn = oblique vein of left atrium & coronary sinus
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Formation of Ventricular Septum
1. Growth of Endocardial cushions
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Septum Formation in A-V Canal
1. Endocardial cushions appear. 2. AV canal enlarges to the right. 3 10. Fusion of sup. & inf. Endocardial cushions ( mm.
stage) 4. Rt. & Lt. AV orifices are formed.
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Formation of Ventricular Septum2. Growth of ventricular wall to form Muscular ventricular septum
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1. Medial wall of ventricles form muscular intervent. septum 2. Outgrowth of inf. EC to close interventricular foramen.
(= membranous interventricular septum)
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Formation of Ventricular Septum - 3. Growth of Trunco conal ridges & fusion wit
h endocar di al cushi on
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Formation of Ventricular Septum - 3. Growth of Trunco conal ridges & fusion with endoc
ardial cushion
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Septum Formation in
Truncus & Conus
Fusion of Rt. & Lt. conus swelling = outflow tracts
of Rt. & Lt. ventricle.
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Formation of Cardiac valves
6 wk.
1. Aortic valves & Pulmonary valves (Semilunar valves)
5 wk. 7 wk.
6 wk.
7 wk.
9 wk.
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2. Mitral valves & Tricuspid valves (Atrioventricular Valves)
- 1. Proliferation of mesenchyme in A V orifice. 2. The cords becomes hollowed out by bloodstream. 3. The muscular tissue degenerates, replaced by dense
CNT. - 4. A V valves = CNT covered by endocardium connected to papillary muscles by chordae tendineae.
5. Right = tricuspid valves Left = bicuspid (Mitral) valves
Formation of Cardiac valves
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4 wk(4 mm.)
Arterial System
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dd ddddddd dddddddddd d dddddd ddd&
FateStructureLef t Right
TruncusArteriosus
Root ofPulmonary Trunk(proximal)
Root of Aorta(proximal)
Aortic sac Brachiocephalicartery
Arch of Aorta(proximal)
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Fate of Aortic Arches
FateStructure
Right Left
1st Aortic arches Maxillary a. Maxillary a.
2nd Aortic arches Hyoid a. &Stapedial a.
Hyoid a. &Stapedial a.
3rd Aortic arches 1. Common carotida.
2. I nternal carotida. (proximal)
3. External carotida.
1. Common carotida.
2. I nternal carotida. (proximal)
3. External carotida.
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FateStructure
Right Left
4th Aortic arches Subclavian a. Arch of Aorta &Subclavian a.
5th Aortic arches - -
6th Aortic arches Right Pulmonarya.
Ductusarteriosus & LeftPulmonary a.
Fate of Aortic Arches
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4 mm.
I disappear : rem. = Maxillary a.
II disappear : rem. = Hyoid a. & Stapidial
.
III, IV & VI become larger.
Primitive pulmonary a. is for.
Aortic arches
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10 mm.
I & II disappear
VI connect to Pulmonary trunk
Aortic arches
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Transformation to Adult Arterial System
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Transformation to Adult Arterial
System
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Transformation to Adult Arterial System
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Other Changes in the Arch System
1
3
4
2
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Other Changes in the Arch System
1. Obturation of Carotid duct (Dorsal aorta between III & IV)
2 7. Obturation of Rt. dorsal aorta (at th in tersegmental a.)
3. Lt. subclavian a. shifts to higher point.
4. Recurrent laryngeal n. R dddd dd dddddddddd dd dd =. = hook at Ligamentum arteriosum
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Derivatives of Dorsal Aorta
Intersegmental a.• supply ribs, intercostal m. & spinal cord• - C & L segments supply limbs
Lateral splanchnic a.• supply kidneys & gonads (intermediate mesoderm)
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Derivatives of Dorsal Aorta
Ventral splanchnic a.d ddd dddd ddd• Vitelline a. dddddd dddd ddd:• Umbilical a.: supply placenta & develodddd visceral organ
Without yolk sac• Celiac a. : supply foregut eg stomach• Sup. mesenteric a.: supply midgut eg.
duodenum& i l eum• Inf. Mesenteric a. : supply hind gut eg.
colon& r ect um
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Vitelline and Umbilical Arteries
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Venous System
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Venous System
1. Vitelline veins
2. Umbilical veins
3. Common cardinal veins• Anterior cardinal veins• Posterior cardinal veins
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Vitelline veins
1. LVV are converted into Hepatic sinusoids, Hepatic v. and Portal v.
2. RVV persists as IVC (post-hepatic IVC)
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Vitelline veins
4 - 5 wk
4 wk : form plexus to duodenum & septum transversdd
5 wk : form hepatic sinusoid
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Vitelline Veins
8 : .wk Rt hepatocardiac channel enlarges
12 wk: RVV is converted into IVC (hepatic portion)
8 - 12 wk
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Umbilical veins
1. Differentiation into d dddddd dddddddds
2. LUV & Ductus arteriosus form Liga ment umar t er i osum
3. RUV degenerates
4. LUV (caudal) persists in fetal life
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Umbilical veins
5 wk = RUV & LUV connect to Hepatic sinusoid
4 - 5 wk
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Umbilical Veins
8 - 12 wk
Ductus venosus is formed. Lt. umbilical vein enlarges.
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Anterior Cardinal Veins
7 wk.
1. Anastomosis of AC V shunts blood from L
ACV to RACV& form Le ft Brachiocephalic v.
2. LACV(caudal) degenerates.
3. RACV & RCCV for m SVC
12
3
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Posterior Cardinal Veins 1. Degenerate with the development of metanephric
kidney
2. Persists as common iliac v. & Root of Azygos v.
3. Two temporary venous system develop
a.) Subcardinal v. develops into
LRV, Gonadal v., Suprarenal v., IVC (hepatic segment)
b) Supracardinal vein develops into
Azygos v.
Hemiazygos v.
IVC (lower)
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Fate of Fetal Circulatory Structures
1. Umbilical vein Ligamentum teres hepatis
2. Ductus venosus
3. Umbilical artery
Ligamentum venosum
Medial umbilical ligament
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High oxygen ddddddd ddddddddd in :
I Liver II IVC III Rt. atrium IV Lt. atrium
V Desc. Aorta (at the
dddddddd dd dddddd )
Fetal Circulation
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Changes at BirthCauses :• cessation of placental blood flow• lung respiration
Changes :1. Cl osure of umbilical a. &fo
rmati onof llll. .2. Cl osure of UV & ductus venosus &formati onof lig. teres &li
g. venosum3. Cl osure of ductus arteri osus by bradykinin &formation of
lig. arteriosum4. Cl osure of oval foramen
1
2
3
4
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Lymphatic System
5 wk. origin : mesenchyme or
out growth of endotheliu m of veins
6 primary lymph sacs a re formed :
- 2 jugular lymph sacs - 2 iliac lymph sacs - 1 retroperitoneal
lymph sac - 1 cisterna chyli
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• Rt. & LT. Lymphatic ductd• Rt. & Lt. thoracic ducts
Lymphatic System
• Thoracic duct• Rt. lymphatic duct
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Formation of Conducting System
1. Pacemaker lies in - initially : left cardiac tube - later : sinus venosus
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Formation of Conducting System 2. Incorporation of sinus into Rt. atrium.
3. Sinuatrial node is formed.
- 4. A V node & Bundle of His are derived from cells of a. left wall of sinus venosus (base of interatrial septu) - b. A V canal
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Abnormalities of Heart Position
Dextrocardia : cardiac loop to the left. = Heart in the right thorax associated with d
itus inversus (transposition of the viscera)
Ectopia cordis = Heart on the surface of chest caused by fa
ilure to close the midline
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Common Congenital Anomalies
Etiologic factors:
1. Disorders of chromosome numbe rs eg. trisomy 2 1 , 1 8 or 1 3
2. Familial disorders
3. Teratogenic viral infections : Rubella
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Atrial Septal Defects (ASD)
• Probe patency of Foramen ovale
• Left to right shunt of blood
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Atrial Septal Defects (ASD)
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Ventricular Septal Defect
• 1500
• Trisomy syndrome
• ddddddd d dd ddddddd dddddddddddddddd dddddd9 0 %
• Shunted from left to right ventricle
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Ventricular Septal Defects
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Tetralogy of Fallot
• 18500
• Four anomalies : 1. Ventricular septal defect 2. Pulmonary artery stenosis 3. Overiding aorta 4. Right ventricle hypertrophy
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Tetralogy of Fallot
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Tricuspid Atresia
• 1 in 5 0 0 0• Fusion of tricuspid valves• Patent oval foramen• Ventricular septal defect• Right ventricle atrophy• Left ventricle hypertrophy
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Tricuspid Atresia
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Patent Ductus Arteriosus
• 13500
• Shunting oxygenated blood to pulmonar y artery
• Prostaglandin synthetase inhibitors eg. dndomet haci n can promote closure of Duct
us ar t er i osus
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Patent Ductus Arteriosus
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Abnormalities of Semilunar Valves
1. Transposition of great vessels
2. Pulmonary valvularstenosis
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Abnormalities of Semilunar Valves
4. Aortic valvularddddddd
3. Aortic valvulardddddddd
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Abnormalities of Great Vessels
1. Patent ductus arteriosus
2. Preductal & Postductal coarctation of aorta
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Abnormalities of Great Vessels
3. Abnormal origin of Right subclavian a. 4. Double aortic arch
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Abnormalities of Great Vessels
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Abnormalities of Venous Drainage
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Abnormalities of Venous Drainage