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    13 views9 pages

    2 5314322773764474419 PDF

    Uploaded by

    Thisha Mohan

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    © All Rights Reserved
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    SYSTEMIC EMBRYOLOGY DEVELOPMENT OF CARDIOVASCULAR SYSTEM © Primordia of cardiovascular system from which the heart, blood vessels and blood cells develop is mesoderm, Cardiovascular system begins to develop in the middle of 3rd week. WI EAR Heart develops from splanchnic mesoderm forming the cardiogenic area. Primordial heart develops as two endothelial hheart tubes which fuse in cranio-caudal direction to form a single tubalar heart. Endothelial heat tube is surrounded bya layer of mesoderm known as myo-epicardisl mantle, which gives tise to myocardium and visceral pericardium (epicardium). Myo-epicardium then secretes a thick layer of extracellular matrix called eardiac jelly that separates it from tubular heart", Thus developing heart consists of three layer : (2) endocardium, (i) myocardium and (ii) epicardium (serous pericardium). © Tubular heart has following components, eranio-caudally. 1. Butbus cardis :Itis the cranial most part and is subdivided into = i) Truncus arteriosus (distal parg : Its the most cephalic part oFendothelial heart tube (tbular heart), Ielater forms ascending aorta and pulmonary trunk. Distal end of truncus arteriosus dilates to form aovile sae ‘which divides into right and left limbs. Each limb is connected with the corresponding dorsal aorta through six aortic arches, ii) Conus cordis (mid portion) : Later forms the outflow tract of both ventricles. ii) Proximal part: It forms the trabeculated past of right ventccle, 2. Primitive ventricle : Along with conus cords it forms the right and left ventricles, 3, Primitive atrium : Primitive atrium will later form right and left atria, Primitive atrium is connected to primitive ‘ventricle by atrioventricular canal 8 Venosus : Its the caudal most part of tubular heart. At its lower end it presents right and left horns, Bach hom receives blood from following three veins = 4) Vitelline vein from yolk sac. Right vitelline vein forms terminal part of interior vena cava, i) Umbilical vein from placenta. ii) Common cardinal vein from body wall. Right common cardinal vein forms superior vena cava, ip), \ Fame men aa af Yr, | caine one \ Conn-( ) | cons saosebesina ; \ | Sambar vwese-() acess tetera} Pinan } partion b> rant | Set an | Su nomsie a= eee we fem sapere, ‘ Primitive i) Rough anterior part —» Primitive atrium ‘atrium (right halp. left half. i) Smooth posterior part—> Absorption of right i) Smooth posterior part—> Absorption of pulmonary horn of sinus venosus®#2 veins ii) Right atrioventricular eanal is also absorbed to ii) Left atrioventricular canal is also absorbed to ‘some extent into right atrium some extent into left atrium fo Interatrial septum separates right atrium from left atrium and is formed by fusion of septum primum with septum secundum. Also know ‘9 Fossa ovaliss the remnant of septum primum®#=. ‘9 Limbus fossa ovalis (annulus ovalis) isthe remnant of septum secondum. Formation of ventricles ‘9 Development of ventricles is as follows = 1. Right ventricle : Right ventricle develops from : ’) Rough part: from proximal part of bulbar cordis and right half of primitive ventricle. ii) Smooth part (infundibulum) : from caudal part of bulbus cordis (conus cordis). 2. Left ventricle : Left ventricle develops from ) Rough part: from left half of primitive ventricle. i) Smooth part (vestibule) : from caudal part of bulbus cordis (conus cords). SYSTEMIC EMBRYOLOGY [ 464] Intraventricular septuin separates right ventricle from left ventricles. Formation of intraventricular septum involves three processes :- ') Formation of proximal bulbar septum, which separates conus cordis part. ii) Formation of muscular part of interventricular septum. iil) Formation of membranous part of interventricular septum. DEVI (T OF VASCULAR RIES ( Arteries associated with primitive heart are>- ') Dorsal aortae are two longitudinal vessels which run through entire length of embryo one on each side of notochord along the dorsal wall of yolk sac. Soon the paired dorsal zartae fuse to form single dorsal aorta just caudal to pharyngeal arches. ii) Aortic arches (arteries of pharyngeal arches) arise from aortic sac on each side and terminate into dorsal aorta. iin ine artery arises from ventral surface of dorsal aorta and supply yolk ste, allantois and chorion. The Vitelline artery will form : (9 celiac trunk (to foregut), (ii) superior mesentric artery (for midgut), and (il) inferior mesenteric artery for hindgut). iv) Umbilical arteries arise from caudal end of dorsal aorta and passthrough connecting talk (which later becomes umbilical cord). Proximal parts of umbilical arteries persist as internal iliae arteries and superior vesical arteries. Distal parts obliterate after birth and become the medial umbilical ligament. Aortic arches and their derivatives © The arterial system develops from the aertie saes. The aortic arches (arteries of pharyngeal arches) arise from aortic sac on each side and terminate into dorsal aortae. There arc five pairs of sortie arches forthe pharyngeal arches I, I, UL, IV and VE (V being absent in human embryo). Derivatives of aortic arches are = 1. Aorticareh I; Itmainly disappears, the swall remaining part forms inferior alveolar artery, branch of maxillary artery, 2 Aortic arch 11: It mainly disappears, remaining part forms hyold artery and stapedial artery. 3. Aortic arch EIT: Itpersists and form i) Common corotid artery. i) First part of internat carotid artery (rest of ICA is formed by eranial portion of dorsal aorta), ii) External carotid artery. 4. Aortic areh IV : The right and left side develop differently: ’)Leftaortic arch IV forms part of arch of aorta which lies between left common carotid and left subclavian arteries. ii) Right aortic arch IV forms most proximal part of right subclavian artery™" (distal partis formed by right dorsal aorta and right 7ib cervical intersegmental artery). The Ieft subclavian artery is formed by left ‘Th cervical intersegmental artery. Aortic arch V does not develop in human embryo", 5. Aortic areh VI: Aortie arch VI forms pulmonary arteries”, Right aortic arch VI loses connection with dorsal aorta. On the other hand left aortic arch VI does not lose its connection with dorsal aorta, It persists as ductus arteriosus during fetal life which enables venous blood to be diverted from funetionless Iungs into descending aorta, After birth ductus arteriosus obliterates to form ligamentum arteriosus™™, ‘SYSTEMIC EMBRYOLOGY [465] Mandibular artery Maxilpry artery \) Definitive derivatives of aortic sac © Right aoitic sae becomes the brachiocephalic artery. Left aortic sac forms part of arch of aorta. SYSTEMIC EMBRYOLOGY [466] Development of major arteries Blood vessel Development components Ascending aorta Truneus arteriosus Arch of sorta 1. Left horn of aortic sae 2. Leftth arch artery 3. Left dorsal aorta Descending aorta 1. Left dorsal aorta beyond 7th cervical intersegmental artery 2. Fused dorsal aortae Brachiocephalic artery Right hom of aortic sac in which right 3rd and 4the arch arteries are opening ‘Common carotid 3rd arch artery distal to extemal earotid bud Internal carotid artery 3rd arch artery distal to external carotid bud and dorsal aorta cranial to attachment of 3rd arch artery Extemal carotid artery New sprout (bud) from 3rd arch artery Subclavian artery Right 1. Right 4tharch artery 2. Right 7th cervical intersegmental artery Left Left 7theervieal intersegmental artery Pulmonary trunk ‘Truncus arteriosus Pulmonary artery 6th areh artery (proximal part) Ductus arteriosus Distal part of left 6th arch artery between pulmonery artery and desending aorta Dorsal aortae and their branches © The dorsal aorta is a paired vessel in the early human embryo. The two aortae fuse caudal toT4, forming a single aorta, Each dorsal aorta, even before the stage of fusion gives numerous branches which arise at right angles to the long axis (right and left branches) and are arranged in three groups - 1. Intersegmental arteries «2 About 30 somatic intersegmental arteries supply blood to developing somites and their derivatives, They form following arteries }) In neck (cervical intersegmental arteries) they form vertebral arteries, 7th cervical intersegmental artery forms complete subclavian artery on let side and part of subclavian artery on righ sie. i) Inthe thorac (thoracic intersegmental arteries) they persists intercastal arteries. Tht ventral divisions anastomose with ventral division of 7th cervical interseemental artery to form internal thoracic artery. ii) Jn abdomen (lumbar intersegmental arteries) they form lumbar arteries, but Sth pair of lumbar intersegmental arteries remain as common iliac arteries. iv) In the sacral region they form the lateral sacral arteries. 2. Lateral splanchnic branches 12 These supply the mesonephros (including adult kidney) and genital ridge (testis or ovary), and part of adrenal gland. 3. Ventral splanchnic branches (vitelline arteries) 2 These form cvetiac trunk (for foregut), superior mesenteric artery (for midgut) and inferior mesentrie artery (for hindgut). Developmental anomalies of aortic arches © Important abnormalities in the development of aortic arch are:~ 1. Double aortic areh results when right dorsal aorta also prest intersegmental artery HE, 2. Right aortic arch results when right dorsal aorta persists and corresponding portion of left dorsal aorta disappears 3. Interrupted aortic arch, ic. absence of a segment of aortic arch results due to obliteration of th aortic arch ‘om the let side which normally forms the sogment of aorta which lies between left common carotid and lft subclavian arteries. Thus the part of arch of aorta between left common carotid artery and lefi subclavian artery is absent andthe ascending aorta ends by supplying the artery arses from distal segment and receives blood through patent ductus arteriosus. 4, Abnormal origin of subclavian artery : Normally right subclavian artery if formed from right 4th arch artery s distal to the origin of the right 7th cervical ‘SYSTEMIC EMBRYOLOGY [ 457] However, sometimes the right Ath arch and proximal part ofright dorsal aorta obliterate and right 7th cervical intersegment artery and right dorsal caudal toitare continued as right subelavian artery. 5. Left common carotid artery mostly arise from arch ofaorta but in 30% cases it may arise from brachiocephalic trunk which is most common variation of branching pattern of arch of aorta". VENOUS SYSTEM ‘o Veins of primitive cardiovascular system at 4th week which drain into primitive heart include three pais :() vitelline veins, (i) umbilical veins and (ii) common cardinal veins. However, during Sth to 7th weeks, a number of additional pairs of veins are formed which include : () subcardinal veins, (i) saerocardinal veins and (ii) supracardinal veins. All these veins can be divided into three groups ‘= A) Vitelline veins ‘The right and left vitelline veins drain into right and left hom of sinus venosus, respectively. Vitelline veins have three parts |) Infrahepatic part: Derivatives of this part are portal vein and superior mesenterie vein”. 4) Intrahepatic part: Derivatives ofthis part are intrahepatic branches of portal vein and tributaries of hepatic vein’”””. i) Suprahepatic part : This part form the right and left hepatocardiae channels, Left hapatocardiae channel «isappears and right hepatocardiae channel (common hepatic Vel) persists as hepatic segment of inferior vens.cava(iVCy"""”, B) Umbilical veins ‘© Umbilical veins develop in the chorionic sac (primordial placenta), travel in umbilical cord and drain into right and left horns of sinus venosus. ‘0 Whole of the right umbilical vein and proximal part of left umbilical disappear. The distal part of wubilical vein serves to carry oxygenated blood from placenta to fetus. Blood cartied by umbilical vein course throgh, to join portal vein. The duetus venosusiis a bypass sbunt between portal and IVC, Most ofthe umbilical venous blood shunts through the ductus venosus to IVC, After birth, left umbilical vein is obliterated to form igamentuns teres 420 (of liver) and ductus venosus is obliterated to form ligamentunt venosum. ©) Cardinal system of veins © Adult venous system is developed from three embryonic venous systems and four major transverse ‘anastomoses between them. These are := 1. Embryoniesysiems(three in number) 3) Cardinal venous system i) Subcardinal venous system ii), Supracardinal venous system 2: Transverse anastomoses between embryonic venous system (four in number) ) Brachiocephatic anastomosis between tight and left anterior cardinal veins. ji) Azygous anastomosis between right‘and left supracardinal veins. ii) Renal anastomosis between right and left subcardinal veins. jv) Iliac anastomosis between caudal ends of two posterior cardinal veins. ‘Common cardinal veins ‘© Common cardinal veins are formed by anterior and posterior cardinal veins. Right and left common cardinal veins drain into right and let horn of sinus venosus, respectively. {Anterior cardinal veins drain the blood from cranial part (head and neck and upper limb) of fetus, and join ‘vith posterior eardinal vein to form common cardinal vin. THibutaries of anterior cardinal veins ae eervfeal (to 7) ntersegmental veins. Oblique cross connection brachiocephalic anastomosis) occurs between {0 anterior cardinal veins ii) Posterior cardinal veins drain lower part. Attheir cephalic end they unite with anterior cardinal vein to form ‘common cardinal veins and at their caudal end they make a transverse anastomosis (iiae anastomosis) ‘Tributaries of posterior cardinal vein are 12 thoracic and 5 lumbar intersegutental veins. Subcardinal veins ‘© The subeardinal veins are formed in relation fo urogenital ridges and mainly drain the developing kidney. Renal anastomosis (inter-subcardinal anastomosis) develops between two subcardinal veins. Cranial part of right subcardinal vein also establishes an anastomosis with right hepatocardiae channel, and this anastomosis channel forms part of hapatic segment of IVC. Supracardinal veins © Supracardinal veins are longitudinal veins which communicate cranially and caudally with posterior cardinal veins. Azygous anastomosis develops between two supracardinal veins, Amerie cardinal vin \eersopmenta ine anos ‘eins ae . Left common cardinal von Thoracic esonepvie an gonadal ving Intersepmenel Mesonephros tl i Posteo arial vein Intersogmentat ‘The cardinal venous systom draining the body wall and urogenital ldges at 4 wooks Anterior exci! voin Brechiocephale anastomosis. 7 intersegmental vein Tntrsogmontl vein ‘Unbielvein — Vittne vin — Posterior earinal vein Lett supracarainal vin ‘zygosanastomesis, —— tat adrenal gland — Let subesdinal vin —— Ranal anastomosis ‘ih Lumbar intersginental vein tae snastomosle Caudal vain ‘Tho cardinal, suscardinal, and supracardnal systems and thelr transverse anastomosis © Derivatives of anterior cardinal venous system are - 1 Superior vena cava (SVC) is derived from (i) right anterior cardinal vein (proximal to brachiocephalic anastomosis), and (i) right common cardinal vein, Right brachiocephalic vein is formed by right anterior cardinal vein (part which lies between right 7th cervical intersegmental vein and brachiocephalic anastomosis). Left brachiocephalic vein is formed by brachiocephalic anastomosis (between two anterior eardinal veins) Subelavian veins are formed by 7th cervical intersegmental vein, Internal jugular veins are formed by anterior cardinal veins (part which lies cranial to their junction with 7 cervical intersegmental vein). External jugular veins arise as secondary channel (not derived from anterior cardinal veins) Left superior intercostal vein is formed by regressed part of left anterior cardinal vein (caudal to transverse anastomosis) and cranial part of posterior cardinal vein, ‘Verteral veins are developed by longitudinal anastomosis between C1 to C7 intersegmental veins and intercostal SYSTEMIC EMBRYOLOGY [ 469] 9 Derivatives of posterior cardinal veins, subeardinal veins and supracardinal veins are |. Inferior vena cava is derived from: 8) Hepatic segment of IVC is derived from (i) right hepatocardiac channel, and (ii) anastomotic channel between subcardinal vein and right hepotocardiae channel b) Renal segment of IVCis derived from right subcardinal vein. This part receives both renal and suprarenal ©) Postrenal segment of IVC (major part of IYO) is formed by (i) anastomosis between right supracardinal and subeardinal veins“, (i) right supracardinal vein Gower part), and (i right posterior cardinal vein lowest part). ‘Gonadal veins develop from subcardinal veins (distal part below inter-subcardinal or renal anastomosis). Suprarenal veins develop from subcardinal veins (proximal part above inter-subeardinal or renal anastomosis). Right common iliae vein is derived from right posterior cardinal vein (most caudal part) Left common ilie vein develops from transverse anastomosis between lower end of posteriér cardinel veins. [ight renal vein isa mesonephrie vein that drains into renal segment of VVC (which is derived from upper part of right subcardinal vein) 7. Left renal vein develops from three sources: (i) mesonephric vein (drain into left subcardinal vein), (i) let subcardinal vein (small part) and (i) pre-aortic itersubcardinal anastomosis aa Right Lert Left intemal joguar vein Cervical intorsegmental vein. Vertebral vain Left brachiocephalic vein ‘Oblique carsiae vain Right brachiooophale vein Suiblavian vein Highost intercostal vein Ltt superior intrenstal vein +-Great cardiac vein Arch of vena azygos intercostal veins }—Vietine vein Opening of inferior vena cava Right vitotine vein. Hepatic part of interior vena cava. Accessory emiazygos vain ‘Azygos vein isles Transverse azygos vein Sulbearinal vein -Adrenel vein subcostal vein Right sub-supracardnal anastomosis ‘Asconding lumbar vain Kidney with metanepic vein Supracerdinal vein Common ia vain Extomal fac vein Internal ae vein Development of adult veins fam cardinal, subcardinal and supracardnal system: Atophiad veins ave shown in broken ines Azyogos system of veins i) Aaygos vein develops ftom right supracardinal vein and cranial part of right posterior cardinal vein, ji) Hemiazygos vein develops from left supracerdinal veins. iil) Transverse azygos vein develops from azygos anastomosis (transverse anastomosis between supracardinal veins) SYSTEMIC EMBRYOLOGY [470] -velopmental anomalies of vein: A) B ‘Anomalies of SVC 1. Left superior vena cavais formed when left anterior cardinal and common cardinal veins persist and the ight ones obliterate, Left SVC opens into right atrium through the coronary sinus“, 2 Double superior vena cava occurs due to persistence of leit anterior cardinal vein. The right SVC opens

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