1.

Early Heart Development

Angiogenic Yolk sac Armiollc Blood vesseh
celduslefs cavily developing 111
COMeding stal(
aodchonon
• Develops from mesoderm

• Earliest organ to develop ("'day 18) / ,

I~
• Starts beating from day 21 or 22
\(_ ~ ~ •
•
• Heartbeat can be detected by '
• , • 0
,
•Q •
sonography by week 5 ''
Cardiogenic mesoderm
" '0
• Develops fr~ m Cardiogenic mesoderm

• Folding and flexion of the embryo results

' ~--0
Fig. 6.1 A longltudlnal section of an embryo at about 11 days,
showln9 th• formation of extra-.mbryonk blood vtuels.

in migration of the developing heart and

establishing the normal anatomical
relationships with foregut and diaphragm

Dorsal view of embryo (approximately 18 days)

 1. Early Heart Development - pericardial cavity

Two ( 2) primordial endocardial heart tubes develop from the cardiogenfc mesoderm.
Simultaneously space (pericardial coelom) splits the cardiog enic mesode rm into a dorsal somatic part (D)
and a ventral splanchnic part (V).

PericardiaJ coelom

B
Umbilical
-..asicla
Angiobtastic cords
Endoderm canalize to form Mesode rm
primord ial heart tubes
 1. Early Heart Development - tubular heart and perlcardial
cavity

P1ane of section
for A,C& E

• Lateral folding of the embryo brings the heart

tubes together➔ forms a single median heart
tube ••see ectopia cordis

• The primitive heart tube will become the

endoatrdium and the mesoderm surrounding the
tube gives rise to the myocardium and
epicardium
 1. Early Heart Development - tubular heart and pericardial cavity
Head flexion moves the heart tubes, pericardial coelom and septum transversum from •in-front of the
brain" to a position ventral to the foregut.
The heart tube is suspended by the dorsal mesocardium .

N!ftOA

,~
____....l. . ......t-L,L, . .._.,,._...(QA---,

_, s.-~ ~~
 1. Ea·rly Heart ,D evelopmen t - transverse pericardial sinus

I Remnant of dorsal
mesocardium Transverse
pericardial sinus
Par~cardtal
space

wan of heart ttJbe ........---,

8
A

Level of Cross section C

I
I
l C
0

transverse pericardial sinus ts formed by apoptosi s of the cent ral part of the dorsal mesocardiurn ➔ th i s
:es a communication between left and right sides of the pericardium
SOM.1~l 8 PM1.3.CPR-2..ANAT.CV. 1001
 2. Tubular heart - Componen ts and blood flow
t
~r"'Jri: ~JS .:..rter OSUS
1

--•·- ~
· BlllbtlsCordis
I
,, ,,'
,,

I
I
I
I
t I
I
I
\
\
\
\

'',

Embryonic tissue, placenta and yolk sac

• The primitive heart has a cephalic arterial end continuous with the aortic sac and a caudal venous end
• Differential growth results in several bulges separated by grooves
 2. Tubular heart - cardiac looping
Atna now
located
oot //')l
;. I / dorsally

Pertebrcium

lt~ lt

, ,
a·r vm

~~tnc.• -

Future left
C ventricle

Growth of the heart t ube forces complex folding - Viewed from the front the bulbus co rdis and primordial
ventricle loop to the right (bufbo-ventn cular loop) ➔ 0 -loop" or "dextro loop .
D-Loop,ng results 1n :
• Venous. end of the tube ( atria and srnu s venosus) now located posteriorly
• Artena l end {ventricle, bulbus cordis and truncus) now located anteriorly
SOM ta, BPM1 3 CPR2 ;\NAT CV 1002
 Clinical note I - Dextrocardia and Situs inverus

NORMAL

V.ntrtde

- Atrium

DEX T'ROCARDIA

__.... Truncua arwuo•u• O

- - - -- V.Otncio
Look closely, can you see the difference between A and B?
- -- Atr-iu,n ----

• s.nua ~au•
• .____,._.. ............... -. ....... ,. - - - - ~ ---~ c. ..,n

• 0-Loop (normal) positions apex to left

1
L-loop positions apex to right or Dcxtro card 1a ( A) .
· Dextrocardia may be isolated (A) or a component of complete situs inversus (B) where abdominal organs are
also found reversed
SOM 1M BPM1 3 CPR 2 ANAT CV 1003
 2. Tubular heart - Embryological fates components
ALL of the heart tube must be partition~d into right and left chambers/vessels to form the four chambered
heart and great vessels. Partitioning is accomplished by growth/development of the following:
• Endocardial cushions (A-V cushions)
• lnteratrial septum
• , lnterventricular septum (muscular and membranous parts)
• Spiral (aorticopulmonary) septum

Tube Right Left

Truncus arteriosus Pulmonary trunk Ascending aorta
Bulbus cordis Conus arteriosus Aortic vestibule 0
Primordial ventricle Trabeculated part of right ventricle Trabeculated part of left ventricle

Right horn of sinus venosus Smooth walled or right atri'um(sinus

I
venarum)
' Left horn of sinus v-enosus Coronary sinus
, Pri mordial atrium Rough walled part of right atrium Rough walled part of left atrium
1
SO..i 1aa 8PM 1 J cm 1 ANA T CV 1 1C
 3. Partitioning of the atrioventricular canal
Outing the 41tt and 5 weet swe-Hings

i
appear on the anterior and po~ior
watts of the common ~trioventricular
c.anat ➔ .-.. .,1 ~
&. _
~
;;! '".,. !'-. ~ ~• , ... .
deriived m.amJy from Ventral .and dorsal
(/)
cardiac mesendlyme (Jen, ) ~doca.rdial
cushions (EC)

Sagjtta1 section B SafljttaC section

A

Cushions 1row towards each

other and fuse forming Rt and
U AV canal~.
Tl. e::r a;>o forrr. the mitral and
F ~ [C
trice s pid valves
LeftJt.V
Don.i EC
cmill

F ~ tidO..alf'INI
~ l o r ~ AV
C frontal ~, tioo D Frontal ,_ect,on ..
~

SOM 1• SPIA1 l CPR.l.AHAT C\/ 1001

SOI,, 1111 8PM1 l C?R 2 A.NAT CV 1011
 4. Atrial Partitioning
• Septum primum grows from
the roof of atrium towards
endocardia,I cushions

'
• The space between the inferior
edge of septum primum and
the endocardial cushions is
foramen primum

• Growth of septum primum PertorabOM rc,,p,esent the d M , ~

closes foramen - for•men s«undlxn "' seprum s,ttrnum

• Simultaneously perforations ~!t..:~+t----- Foramef\ pnrrum

appear in septum primum
~ - - - Fused endOClrdal
which forms foramen cus;tlk)ns 0

secundum
B
 4. Atrial Partitioning

Septum secundum grows

downward, eventually --- - - - - Septum ·secunduln (upper kmt>)

- - - - - F«amenaecundum I
overlapping foramen
secundum . VlthO of (Nat lolamCln
(dofwed trom sec,cum pM'IU:ffll

- Sef)tumsacundum
(lower limb)

E e,

Remnant ol lof1lmon ~
The opening between the free
edges septum secundum and
sept um primum is called foramen
ovale or oval foramen o.t torwnen doAd
t,v V41lM> ~ Soq,mcn ovato

SOM.1ai.BPM 1.3.CPR.2.ANAT.CV. 1006 G

 4. Atrial development - Partitioning

- ~- - - - - - -- Superior vena cava

Oval toramen open

Interior vena cava

(carrying well•
oxygenated blood)

H
0

Septum primum (thin and flexible) acts like a flap valve for foramen ovale - the flap is open
when right atrial pressure exceeds left atrial pressure - allowing shunting of blood from the
right atrium to the left atrium (this is an important Right ➔ Left shunt in intrauterine
circulation)
 4.Atrial development- formation of right atrium

PriMOfdi.al
-- for.-:4men
. Sinus venaru .
OVJIP

f u(ur(\ SVC

Right horn Coron.ary !:i.tnU \

and val~e

U'ft horn

.Differential growth of the sinus venosus results in changes in the primordial atrium:
• Right horn becomes larger, is absorbed into the right atrium - sinus venarum, the smooth~walled part
of right atrium where the Superior vena cava and Inferior vena cava enter
• Left horn is smaller, becomes the coronary sinus SOf.t 1ai.BPM1 .3.CPR..2.ANAT.CV. ·1 001
 4. Atrial developmen t - formation of left atriu m

Part of the Left at rium ·forming

~~~
J--- Primordial pulmonary vein from primordi'aJ pulmonary vein

- Primordial left atrium

8
A

- Smooth walled part of left atrium

D
C
Pulmonary veins are progressively incorporated into the wall of the left atrium-.
The oblique pericard ial si, nus is formed when the veins become incorporated into t he atrium .
The (rough-waUed ) auricle is derived from primordial atrium.
SOM.1ai 8PM 1.3.CPR 2.ANAT.CV. 1005
 4. Atrial developme nt - summary

AUIKl~s( right and left)

from primitive atrium

ui\U te1'minafr~ from

v~tve of right sinus venosus

~inu~ venjrum
from right h-0r n o f s-inu\
vcnow~
Smooth part of wa11
Pulmonary ve-in-s

Umbus of the oval fossa from

se,pturn ~undum
Coronary sinu~ and valve from
left sin us ~nosus and v.1lve
0
OV.tl foss.. from
v~tve of foramen ov~le

SOM.1ai.8PM1 .3.CPR.2.ANAT.CV.1005
4. Atria development: Clinical notes Ill - Atrial Septal Defects (5 types)
Normal
Probe w•nt foromtn oval•

WflA <>f noht vontrdo

f ossa ovah
1

~ ~ - - -

ln1ernof vena cava

Oval foua

SOM.1aiii.BPM1 .3.CPR.2.ANAT.CV.1008
 4. Atrial partition ing: Clinical notes Ill - Atrial Septal Defects

Nof m.,I tor ,lJnc.'n

~ laf1}8 bameo ~
ov.lle llntQ'll ASO)

Sho• t ,t.,.J>tmn
l)fllllA.Jm

fenestrations in
septum primum

2. Ostium secundum type ASD's are defects of the oval fo,ssa :

• Defect in septum secundum ➔ large foramen ovalis
• Excessive resorption of septum primum ➔ short septum primum
• Excesstve reabsorption of septum primum and abnormally large foramen ovale
• Abnormal reabsorption of the septum ~ imum ➔ fenestrations SP
SOM.1aiti.BPM1 .3.CPR2..ANAT.CV.1008
 4. Atria,1 artltionin : Clinical notes Ill - Atrial Se ~al Defects
5. Common atrium
3.Primum type This defect is due to FAILURF of
• Failure of closure of foramen primum P ~ f~
septum primum and secundu m to
• The AV valves usually abnormal. P"1"'Uffi
(LOWA.SO) develop
• Often present in Down Syndrome
{endocard ial cushion defect)

jfigh ASO (M41r SVC)

4.. Sinus venos us type
• Incomplete resorption of
sinus venosus into right
atri um OR abnormal
development of upper part
of septum secund tsn

V
'--- --- --- --- --- --- --- --- --- SOM. ,am.BPM 1.3.CPR.2.ANAT.cv. , oos
 5. Partitioning the Bulbus cordis

tkllbu-, cordi\

Muscul~ int~nt ricul..-r ~um

AonKOC>Ulmonary /spiraJ ~ ptum

lnterwn t ric.-uiar
~'f)Cum

The v~ntricular outflow tracts and truncus arteri.osus which must be partitioned into an aorta and pulmonary tr unk
How , Conotruncal swellings derived from neural crest cells devetop: 1.Bulbar ridges in the bulbus cordis and 2._!runc
--=a..-in the tru.ncus arterio sus
8ulbar ridges fu~e w ith endocardial cushions ➔ divide-s bulbus cordis into right and left parts (outflow tract s of the
.u• ntr,c.les): conus arteriosus and aortic vestibule.
 6. Partitioning of the Truncus Arteriosus

The truncus arteriosus forms the

aorta and pulmonary trunk

Butbar ridges align above with

· ' truncal ridges and with endocardial
cushions to form the
L ort,copulmonary A

SOM.1ai.BPM1 .3.CPR.2.ANAT.CV.1010
 6. Partitioning of the Truncus Arteriosus
Trunu l ridges grow towards each other while undergoing ~ 180 deg,ee splr~lins

0
P\.Mn()n aty ttri

P\Jtmoniry tru,yk

G H

Aortic opulm onary septu m grows in a spira.l patte rn (spiral septu m) resulting
in the aorta leaving the heart poste rior to put mona ry artery

SOM 1• BPt/4 1 3 ~ 2.ANAT CV 10'10

j
 7. Development of the Semilunar valves
Mila
I

T~& Trunc.aJ rldgM

Myoc.ar-d 1um

Leve-t o1
Bu'bus sectk>n B
cordlS
Subendocardial
Valve swellings
Pulmonary
A 8ul>arrldge$ 8 Ven:raJ vatv-o swet11ng C trUllk
0

• The semilunar valves develo p from subendocardial swellings at the aorta and pulmo nary ostia.
• Ne·w studies show neural crest involve ment.
• Spiraling ·o f the ao.rticopulmonary septum results in rotatio n of the vessels and valves

SOM.1ai .8PM1 .3.CPR.2.ANAT.CV.1012

 8. Partitioning the Primordial Ventricle

Rq'\l...,te.tl
~ !h.'V'..lr
L......
Prloordlal (rnusaJtlf)
, ~ S4iJ,tum

lat ........
cd
,_.~ CAM

The primordial ventricular septum divides the primordial ventricle into left and right parts ➔ form the muscular
part of the IV septum.
The membranous part of the interventricular septum is complex➔ formed by tissue from l .Fused endocardial
cushions, 2.Fused right and left bulbar ridges
 a.Ventricular partitioning - Clinical notes IV: Ventricular Septal Defect (VSD)

Membranous type VSD is the most common of all

congenital heart diseases (-is%)
endocardial cushions to fuse with
the primordial IV septum and the
bulbar septum

Can have associated AV valve (usually mitral)

abnormality
L ➔ R shunting of blood
Endocardial cushions are involved in formation of
• lnteratrial septum,
• lnterventricular septum
• AV valves
• Endocardial defects therefore can result in
multiple and severe congenital heart defects.
• VSD ( membranous type)
• ASD ( Pr1mum type)
SOM 1a. 8PM1 3 CPR 2 ANAT CV 10 11
 9.Role of neural crest cells in heart developme nt

• Migrating neural crest cells from the region of

hindbrain form the spiral septum (truncal) and

bulbar septum essential for :- NE

• normal partitioning of the truncus arteriosus

( aorta and pulmonary trunk)

• formation of the membranous

interventricular septum

• partitioning of the bu Ibus cordis into right

Thymus
and left ventricular outflow tracts. Primordium
Outflow tract Heart
• Neural crest cells form smooth muscle of the
aorta and pulmonary trunk and probably the

semilunar valves SOM.1ai.BPM1 3.CPR.2.ANAT. CV. 101 3

 --- na tal Clre11latlon

• Closure of f orome.n ovale

- Fossa ovali.s and limbus of f ossa
ovolis

• Closure of ductus arteriosus

- Ligome.ntum arteriosum

• Closure of the ductus venosus

- Ligcunentum venosum Or;pt PS 5 _,_,.

• Contraction and fibrosis of the

umbi.Ucaf vein
- Ligarnentum tere s hepatis

SOM 1a, 8PM1 3 CPR 2 ANAT CV 1103

.. • - - - " ' - • " " ' " - - - . . .
--•'111>-·