Lecture (1): ANATOMY OF MEDISTINUM, PERICARDIUM AND

HEART

Mediastinum

Definition: soft tissue space between the 2 lungs and pleurae.

Boundaries:
- Anterior: sternum& costal cart. - Posterior: the thoracic vertebrae
- Two sides: mediastinal pleurae. - Superior: the thoracic inlet.
- Inferior: the diaphragm
Divisions of the Mediastinum:
A- Superior mediastinum
B- Inferior mediastinum: divided into;
- Anterior mediastinum.
- Middle mediastinum.
- Posterior mediastinum.
NB: Superior and Inferior mediastina are separated by imaginary line extend from
sternal angle anteriory to lower border of 4th thoracic vertebra posteriory

Superior mediastinum
Boundaries:
- Anterior: Manubrium sterni.
- Posterior: upper 4 thoracic vertebrae
- Two sides: mediastinal pleurae.
- Superior: thoracic inlet.
- Inferior: imaginary line & inferior mediastinum.
Contents of the superior mediastinum
1- Retrosternal layer: contain thymus or its rudiment;
2- Venous layer:
- right and left brachiocephalic V. - superior vena cava.
3- Arterial layer:
- Arch of aorta and its 3 branches;
- RT and LT phrenic and vagus n.
4- Tubal layer
- Trachea.
- Esophagus.
- Left recurrent laryngeal nerve
- Thoracic duct.
Anterior mediastinum
Boundaries:
- Anterior: body of the sternum. - Posterior: middle mediastinum.
- Two sides: mediastinal pleurae.
- Superior: imaginary line & superior med. - Inferior: the diaphragm
Contents:
1- Sternopericardial lig.(sup. & inf.)
2- remnants of thymus gland.
3- anterior mediastinal lymph nodes 4- fat.
Middle mediastinum
Boundaries:
- Anterior: anterior mediastinum..
- Posterior: posterior mediastinum.
- Two sides: mediastinal pleurae.
- Superior: imaginary line & superior mediast.
- Inferior: the diaphragm
Contents
1- heart 2- pericardium(fibrous and serous).
3- great vessels of heart(aorta, pulmonary, SVC and IVC).
4- phrenic nerves, pericardiacophrenic vessels
5- lymph nodes. 6- fat.
 Posterior mediastinum
Boundaries:
- Anterior: middle mediastinum.
- Posterior: lower 8 thoracic vertebrae
- Two sides: mediastinal pleurae. - Inferior: the diaphragm
- Superior: imaginary line & superior mediastinum.
Contents:
① principal bronchi. ② thoracic part of
esophagus.
③ descending thoracic aorta. ④ thoracic duct.
⑤ azygos and hemiazygos V. ⑥ vagus nerves.
⑦ sympathetic trunk and lymph nodes.

Pericardium
- It is a double-walled sac around the heart composed of:
- A superficial fibrous pericardium
- A deep two-layer serous pericardium formed of:
1- Parietal pericardium (outer) lines the internal surface of the fibrous
pericardium
2- Visceral pericardium (inner) or epicardium lines the surface of the
heart
3- Pericardial cavity: fluid-filled cavity between visceral and parietal layers.
Fibrous pericardium: conical in shape; its apex directed upwards and
base directed downwards.
- Its apex fused with the coats of ascending aorta, pulmonary trunk,
pulmonary veins and SVC.
- Its base fused with central tendon of diaphragm.
Relations:
- Anteriory:
= sternopericardial lig. = ant. Chest wall. = lungs and pleurae
- Posteriory: descending aorta and oesophagus.
- On each side: phrenic n., pericardiacophrenic A, lungs and pleurae.
Serous pericardium: formed of 2 layers:
- Parietal (outer layer): lines the internal surface of the fibrous pericardium.
- Visceral (inner layer): or epicardium lines the surface of the heart
- The 2 layers are separated by the fluid-filled pericardial cavity filled
with pericardial fluid
Functions of serous pericardium:
- Protects and anchors the heart
- Prevents overfilling of the heart with blood
- Allows for the heart to work in a relatively friction-free environment.
Sinuses of serous pericardium
1- Transverse sinus:
It is a transverse passage inside the pericardial cavity. Its boundaries:
- Anteriory: pulmonary trunk and ascending aorta.
- Posteriory: SVC, RT and LT atria.
- Above: RT pulmonary artery.
- Below: the 2 atria.
2- Oblique sinus:
visceral pericardium ascends on diaphragmatic surface of the heart. It is
then reflected downwards to form parietal layer of serous pericardium.
This sinus lies behind the LT atrium and has the following boundaries:
- Anteriory: back of LT atrium.
- Posteriory: fibrous pericardium
- On LT side: 2 LT pulmonary veins.
- On RT side: 2 RT pulmonary veins.
Blood supply of the pericardium
 - Fibrous and parietal serous: by pericardiaco-phrenic and descending
thoracic aorta.
- Visceral: as the heart(coronary vessels).
Nerve supply of the pericardium :
- Fibrous and parietal serous: as thoracic wall(intercostal nerves)
- Visceral: autonomic NS(sympathetic and parasympathetic).

THE HEART
Site: located directly behind sternum, in the middle mediastinum, with its
⅔ LT and its ⅓ RT to midline.
Axis: downward, forward and to the LT(from base to apex).
Size: approximate size of clenched fist
The heart wall: formed of;
- Epicardium: outer layer
- Myocardium: middle layer
- Endocardium: inner layer
Shape: the heart is cone shaped, has apex,
base , 2 surfaces and 4 borders:
Apex -Formed by left ventricle.
-leftmost, lowermost, part of heart.
- Lies at LT 5th intercostal space 9 cm from midline.
Base - Formed by left atrium mainly.
- related posteriory to posterior mediastinum contents
(descending aorta, esophagus, azygos vein, thoracic duct).
2 surfaces - Anterior - Behind sternum and attached ribs.
(sterno-costal) - Formed by LT vent (⅓), RT vent (⅔)
- Inferior - Lies on the diaphragm.
(diaphragmatic) - Formed by RT vent(⅓) ,LT vent(⅔)
4 borders Right border Formed by right atrium.
Left border.  Formed by left ventricle mainly.
Lower border by right ventricle + apex of heart.
Upper border  Formed by both atria
 Internal features of the Heart(Chambers of the
heart)

1- Atria of the heart:

Rt atrium Lt atrium
Position: - lies anterior and Rt to Lt atrium - lies behind and to the Lt of Rt
- forms Rt border of the heart. atrium
- share in sternocostal surface of - forms the base of the heart.
the heart.
Its Overlaps the Rt anterior aspect Overlaps the Lt anterior aspect
auricle: of root of pulmonary tract. of root of pulmonary tract.
Its cavity: Divided by crista terminalis into: Its cavity is generally smooth
1- posterior smooth part. except its auricle which show
2- anterior rough part: due to few musculi pectinati.
musculi pectinati.
Interatrial Show fossa ovalis and annulus Showa faint impression
septum: ovalis. corresponding to fossa ovalis
Veins It receive deoxygenated blood It receive oxygenated blood
draining from all the body except lungs returning from lungs through the
into: through: 2 Rt and 2 Lt pulmonary veins
1- SVC. 2- IVC. and also vena cordis minimi
3- Coronary sinus
4- anterior cardiac veins.
5- vena cordis minimi
Exit of Through tricuspid valve which Through mitral valve which has
blood has 3 cusps, and leads to Rt 2 cusps, and leads to Lt
from it: ventricle. ventricle.

Heart Valves
1- Atrioventricular (AV) Valves
- Right AV valve (tricuspid): between RA and RV
- Left AV valve (bicuspid or mitral): between LA
and LV
2- Semilunar Valves
- Pulmonary valve: between RV and pulmonary trunk
- Aortic valve: between LV and aorta.
2- Ventricles of the heart:
Rt ventricle
Position: - lies anterior and Rt to Lt
ventricle
- forms inferior border of the
heart.
- Forms Lt ⅔of sternocostal
surface of the heart.
- Forms Lt ⅓ of
diaphragmatic surface of
heart.
Cross Crescent
section:
Its cavity: Divided into:
1- outflow smooth part: called
infundibulum lies below
pulmonary orifice.
2- inflow rough part: below
the opening of tricuspid
valve. This roughness due to:
A- trabeculi carini: few and
coarse
B- papillary muscles(3 ,
anterior, posterior and septal).
C- the moderator band.
Wall 9 mm
thickness
Openings: - It receive non oxygenated
blood from Rt atrium through
the tricuspid valve(has 3
cusps, anterior, posterior and
septal)
- It pump the blood to lung
through pulmonary valve(has
3 semilunar cusps, 1 post and
2 ant.)
Surface anatomy of heart
- Point A: on 2nd LT costal cart. 4 cm from midline.
- Point B: on LT 5th intercostal cart. 9 cm from midline.
Lt ventricle
- lies posterior and Lt to Rt
ventricle
- forms apex and left border
of heart.
- Forms Lt ⅓of sternocostal
surface of the heart.
- Forms Lt ⅔ of
diaphragmatic surface of
heart.
Circular
Divided into:
1- outflow smooth part:
called aortic vestibule lies
below the aortic orifice.
2- inflow rough part: below
opening of mitral valve.
This roughness due to:
A- trabeculi carini: fine and
numerous
B- papillary muscles(2 ,
anterior and posterior).
C- no moderator band.
27mm
- It receive oxygenated blood
from Lt atrium through the
mitral valve(has 2 cusps,
anterior and posterior)
- It pump the blood to body
through aortic valve(has 3
semilunar cusps, 2 post and 1
ant.)
- Point C: on RT 6th costal cart. 3 cm from midline.
- Point D: on 3rd RT costal cart. 3 cm from midline.
- Upper border of heart: line between points A&B.
- RT border of heart: line between points B&C.
- Lower border of heart: line between points C&D.
- LT border of the: line between points D&A.
Surface anatomy of cardiac valves
- Pulmonary valve: at 3rd LT sternocostal junction(heared at 2nd LT space).
- Aortic valve: at 3rd space on LT sternal border (heard at 2nd RT space).
- Mitral valve: at 4th LT sternocostal junction (heard at apex).
- Tricuspid valve: at 4th space behind center of sternum(heard at
xiphisternal junction).
Conducting system of the heart
Definition: it’s a modified special cardiac muscle fibers.
Function: to start and transmitte of cardiac impulse.
Parts of the conducting system:
1- S.A.N.(sinu-atrial): present in the RT atrium behind the SVC opening,
about 1 Cm, its function is to start the cardiac impulse
2- A.V.N(atrioventricular node): present in the IA septum above the
opening of coronary sinus.
3- The AV (atrioventricular bundle): arise from AV node, and divides
into 2 bundle branches
- Right bundle branch: to the RT ventricle.
- Left bundle branch: to the LT ventricle.
4- The Purkinje fibres: distribute the impulse to all thickness of the
ventricular wall.
 Lecture(2): DEVELOPMENT AND CONGENITAL ANOMLAIES
OF THE HEART

Formation of heart tube: the heart is the first functional organ to

develop. It begins to beat at 22 to 23 days.
- Source and Site of heart development: It develops from splanchnic
mesoderm (cardiogenic area).
- The heart primordium begins as collection of angioplastic cells which
soon canalize to form the 2 heart tubes).
- After lateral folding of the embryo, the 2 heart tubes fuse together to
form a single endocardial heart tube
- the heart bends upon itself, forming the U-shaped heart tube, Then the
heart tube turned to loop shaped or S-shaped heart tube
Fate of the Heart Tube: it grows to show 5 alternate dilations separated
by 4 constrictions. These are:
1- Sinus Venosus. 2- Truncus Arteriosus.
3- Bulbus Cordis. 4- Common Ventricle.
5- Common Atrium.
NB:
- The endocardial heart tube has 2 ends:
1. Venous end; Sinus venosus.
2. Arterial end; Truncus arteriosus
- the connection between primitive atrium and ventricle is AV canal

Sinous venousus
At early stage: It formed of body and 2 horns, each horn of the sinus
venosus receives 3 types of veins:
1- Common cardinal(CCV): from the fetal body, it is formed by union of
2 veins:
- anterior cardinal(AC): receive blood from upper ½ of the fetal body
- posterior cardinal(PC): receive blood from lower ½ of the fetal body
2.Vitelline(VV): from the yolk sac.
3.Umbilical(UV): from the placenta.
At late stage:
- an anastomotic channel is formed
between the 2anterior cardinal veins →
shift the blood from left to right side→ enlargement of right horn
Fate:
# RT horn→ smooth posterior part of RT atrium.
# LH + Body → coronary sinus.
# Lt common cardinal vein → oblique vein of Lt atrium.
Partitioning of Primordial Heart: through partitioning of:
1- Atrioventricular canal.
2- Common atrium.
3- Common ventricle.
4- Bulbus cordis
5- Truncus arteriosus
Partitioning of the atrioventricular canal(AV 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 separate primordial
atrium from primordial ventricle.
Partition of the common atrium (interatrial septum).
1- Septum Primum
- It is sickle- shaped septum that grows
from the roof of the common atrium
towards the fusing endocardial
cushions (septum intermedium)
- The two ends of the septum primum
reach to the growing endocardial
cushions before its central part, So the septum primum bounds a foramen
called ostium primum. It serves as a shunt, enabling the oxygenated blood
to pass from right to left atrium.
- ostium primum become smaller and disappears as the septum primum fuses
completely with endocardial cushions to form the interatrial septum.
- 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.
2- Septum secundum.
- Another septum descends on the right side of the septum primum.
- overlap between septum primum and secundum forms an incomplete
partition between the two atria leave an oval foramen forms (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→obliterate the foramen and 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 which also
called the limbus (anulus) ovalis.
Sources of the 2 atria
Rt Atrium Lt Atrium
- Smooth posterior part: derived from the - Rough part: derived
right horn of the sinus venosus from the common
- Rough anterior part: derived from the primordial atrium.
primordial common atrium. - The smooth part:
NB: These two parts are demarcated by the derived from the absorbed
crista terminalis internally and sulcus Pulmonary Veins.
terminalis externally.

Partitioning of Primordial Ventricle (interventricular(IV) septum).

1- Muscular part of the interventricular septum.
- Division of the primordial ventricle is first indicated by a median
muscular ridge, (primordial IV septum).
- It is a thick crescentic fold which has a concave upper free edge.
- This septum surround a temporary connection between the two
ventricles called interventricular foramen.
2- Membranous part of the IV septum: derived from:
1- A tissue extension from the right side of the endocardial cushion.
2- Aorticopulmonary septum.
Spiral Aorticopulmonary Septum
- A spiral septum develops in the truncus arteriosus dividing it into aorta
and pulmonary trunk.
Bulbus cordis
It divides and forms the smooth upper part of the two ventricles.
- In the right Ventricle: It forms the conus arteriosus or (Infundibulum)
which leads to the pulmonary trunk.
- In the left ventricle: It forms the aortic vestibule which leads to the
aorta.
 CONGENITAL HEART DEFECTS(CHD)
1- Anomlies in the position
A- Dextrocardia: Rotation of the heart in
opposite direction→heart chambers reversed in
mirror image.
B- Situs inversus: All organs of the body are
reversed.
C- Ectopia cordis:- Failure of thoracic wall formation→partial or
Complete exposure of heart.
2- Septal defects
A- Atrial Septal Defects (ASD)
- Primum ASD
- Secondum ASD (most common), leads to common atrium.
- Sinus Venosus ASD (high in the atrial septum)
- Patent foramen ovale: due to excessive resorption of septum primum
B- Ventricular septal defect (VSD)
- Perimembranous (or membranous or Roger’s disease:): most common.
- Infundibular (subpulmonary or supracristal VSD): involves the RV
outflow tract.
- Muscular VSD: can be single or multiple.
C- Patent ductus arteriosus(PDA): Persistence of the ductus arteriosus that
joins the Pulmonary artery to the Aorta.
3- Cyanotic defects
A- Fallot’s Tetralogy: 4 components;
1-VSD.
2- Pulmonary stenosis.
3-Overriding of the aorta
4- Right ventricular hypertrophy.
B- Transposition of great arteries (TGA): due to abnormal rotation or
malformation of the aorticopulmonary septum, so the right ventricle joins
the aorta, while the left ventricle joins the
pulmonary artery. often associated with
ASD or VSD.
C- Persistent Truncus Arteriosus: due
to failure of the development of the
aorticopulmonary (spiral) septum.
4- Obstructive defects
- Pulmonary stenosis,
- Aortic stenosis
- coarctation of the aorta,
 Lecture(3):ANATOMY OF THE BLOOD AND NERVE SUPPLY
OF THE HEART

Arterial supply of the heart

The heart is supplied by coronary arteries:

RT coronary artery

Beginning: Anterior aortic sinus of ascending aorta.

Course: It passes at first anteriorly and slightly to RT between the right

auricle and pulmonary trunk, it reaches the AV sulcus and descends to
the inferior cardiac border, curving around it into posterior part of AV
sulcus.

End: by anastomosing with circumflex branch of the LT coronary.

Branches:

1- Marginal artery: it run along inferior

border towards the apex to supply the RT
ventricle.

2- Posterior IV artery: to both ventricles

and posterior ⅓ of IV septum.

3- Anastomotic branches with

circumflex branch of LT coronary artery.

4- Small branches to RT atrium, roots of pulmonary trunk and aorta.

5- Nodal branch in 60% to S.A.N.

LT coronary artery

Beginning: LT posterior aortic sinus of ascending aorta.

Course: larger then RT and supplies large parts of the heart. This artery
lies between the pulmonary trunk and the left atrial auricle, emerging into
the AV groove, in which it turns left. Then it divides into two main
branches.

End: its circumflex branch end by anastomosing with RT coronary artery.

Branches:

1- Circumflex artery: it turns backwards around LT border of heart in

the posterior IV sulcus to supply LT atrium and base of LT ventricle.

2- Anterior IV artery: it descend in ant. IV sulcus then turn backward in

post IV sulcus to end by anastomosing with post IV artery of RT coronary
artery. it supplies both ventricles and anterior ⅔ of IV septum.

3- Small branches to LT atrium, roots of pulmonary trunk and aorta.

4- Nodal branch in 40% to S.A.N.

Venous drainage of the heart

The veins of the heart fall into three groups:

1. Venae cordis minimae. 2. Anterior cardiac veins.

3. Coronary sinus.

Coronary sinus

Site: wide venous sinus, 2-3 cm long, lying in the posterior AV sulcus
between base and diaphragmatic surface of heart.

Termination: it opens into the right atrium between the opening of the
inferior vena cava and the tricuspid orifice.

Tributaries: are the great, small and middle cardiac veins and the
oblique vein of the left atrium.

1- Great cardiac vein : It begins at the cardiac apex, ascends in anterior

IV groove passing to the left to enter the coronary
sinus at its origin.

2- Small cardiac vein: It begins near apex and run

upward with the marginal artery to reach the anterior
 AV sulcus then turns in the posterior AV groove and opens into the
coronary sinus near its RT end. It receives blood from the posterior part of
the right atrium and ventricle.

3- Middle cardiac vein: begins at the cardiac apex, and runs back in the
posterior IV groove to end in the coronary sinus at its middle.

4- Oblique vein of the left atrium: it descends obliquely on the back of

the left atrium to join the coronary sinus near its end.

NB: Veins that don’t open in the coronary sinus;

-Anterior cardiac veins: drain the anterior part of the right ventricle.
Usually 2 or 3. They end in the RT atrium.
- Small cardiac veins(Venae Cordis Minimae): open into all cardiac
cavities.

NERVE SUPPLY OF THE HEART

- The heart is supplied by the autonomic nervous system through 2

cardiac plexuses.

- Origin of the autonomic fibers:

# The sympathetic nerves (6 pairs)--------3pairs in the neck + 3pairs in

the thorax.

# The parasympathetic nerves (3 pairs)---- 2 pairs in the neck + 1 pairs

in the thorax.

- The 2 cardiac plexuses are.

Superficial cardiac plexus Deep cardiac plexus

Site Below the arch of aorta In front of tracheal bifurcation

Formation By 2 autonomic nerves from the By all autonomic branches(8

neck (1 from vagus, 1 from
symath)
Branches 1- to deep cardiac plexus.
2- RT coronary plexus.
3- LT anterior pulmonary
plexus.
pairs) except the previous 2
1- to Superficial cardiac plexus.
2- RT coronary plexus.
3- LT coronary plexus.
4- LT anterior pulmonary plexus.
5- RT anterior pulmonary plexus.
Lecture(4): ANATOMY AND DEVELOPMENT OF GREAT VESSELS
Ascending aorta
Beginning: from LT ventricle at aortic opening (3rd LT intercostals space).
End: level of second right sternocostal joint to continue as arch of aorta.
Course: Runs upward, forward and to the right,
Branches: right and left coronary arteries.

Arch of Aorta
Beginning: continuation of ascending aorta at RT end of sternal angle.
Course: curves upward, to the left and posteriorly, then downward, arching
over left principal bronchus and pulmonary trunk
End: at lower border of T4, to become descending aorta.
Relations of aortic arch
- Anteriorly and to the left: pleura, lung, phrenic n., pericardiacophrenic
vessels and vagus n.
- Posteriorly and to the right: trachea, esophagus, left recurrent n.,
thoracic duct, deep cardiac plexus
- Superiorly: its three branches, left
brachiocephalic v. and thymus
- Inferiorly: pulmonary a., ligamentum
arteriosum, left recurrent n., left principal
bronchus and superficial cardiac plexus

(structures below concavity)

Branches (from right to left )
1- Brachiocephalic artery: extends to
right sternoclavicular joint, bifurcates into
right subclavian and right common carotid
arteries
2- Left common carotid artery
3- Left subclavian artery.

Descending thoracic aorta

Beginning: continuation of aortic arch at lower border of T4.
Course:
- Courses downward on LT side then in front of vertebral column
- Passes through aortic hiatus of diaphragm at
level of T12 vertebra to continue in the abdominal
cavity as abdominal aorta.
Relations of thoracic aorta
- Anteriorly: root left lung, pericardium and
esophagus.
- Posterior: vertebral column and hemiazygos v.
- Right: azygos v. and thoracic duct.
- Left: mediastinal pleura.
Branches of thoracic aorta
- 9 pairs of posterior intercostals arteries
- One pair subcostal artery
- Bronchial branches: two for LT lung
- Esophageal branches
- Pericardial branches.
Pulmonary trunk
- Arises from right ventricle at
pulmonary valve.
- Runs up, back ,and to the left
- Bifurcates inferior to aortic arch into
right and left pulmonary arteries, one for each lung
Pulmonary arteries
- Right pulmonary artery: passes posterior to ascending aorta and superior
vena cava to hilum of right lung
- Left pulmonary artery: passes anterior to descending aorta and left main
bronchus to hilum of left lung
NB: Arterial ligament(ligamentum arteriosum) : remnant of ductus
arteriosus, connects bifurcation of pulmonary trunk to aortic arch

Veins of thorax
- Brachiocephalic veins
- Begin by union of internal jugular and subclavian veins posterior to the
sternoclavicular joint
- Rt and LT brachiocephalic unite to
form SVC.
Superior vena cava
Beginning: by union of right and left
brachiocephalic veins behind the right
1st sternocostal junction.
End: right atrium at lever of lower border of 3rd right sternocostal joint
- it collects blood from veins of upper half of body
Tributaries: azygos vein at level of sternal angle(2nd costal).

Development of Aorta
– Primitive embryonic Aortae:
• Two straight vessels on each side of the midline are present→after
folding, the two arteries are bend to form:
- Dorsal aortae: dorsal to the gut.
- Ventral aortae: ventral to the gut.
- Connecting segment: on each side of the bucco-pharyngeal membrane.
Aortic sac: dilated arterial channel formed by the union of the 2 ventral
aortae, ventral to the pharynx. It continuous with the truncus arteriosus,
caudally. It has a stem and 2 horns(RT and LT). Its branches are:
– 2 ventral aortae.
– 6 pairs of aortic arches around the pharyngeal arches
• Fate of aortic sac:
– The stem & the left horn: involved into the adult aortic arch.
– Right horn: gives off the proximal part of the brachiocephalic artery.
Aortic arches:
• 6 pairs of arteries between the aortic sac
& 2 dorsal aortae around the
pharyngeal arches.
• Derivatives(fate):
– 1st arch: degenerated, may be involved
in maxillary artery.
– 2nd arch: degenerated, may be involved
in stapedial artery.
– 3rd arch: forms the common carotid arteries.
– 4th arch: on the left side, it is involved in formation of the adult aortic
arch. On the right side, it is involved in the formation of the RT subclavian
artery.
– 5th arch: degenerated.
– 6th arch: forms the right & left pulmonary arteries and ductus
arteriosus.
Dorsal aorta:
• It develops from the fusion of 2 dorsal aortae from 4th thoracic down
to 4th lumbar somite.
• Fate:
– Cranial to the 3rd aortic arch: it
forms the distal part of internal carotid
artery (ICA).
– Between 3rd & 4th arches:
degenerated.
– Between 4th arch down to 7th
cervical inter-segmental artery:
involved in the right subclavian artery or in the adult aortic arch on the
left side.
– below 7th cervical inter-segmental artery: degenerated on the right side or
involved in descending thoracic aorta on the left side
• the adult aortic arch develops from:
• Proximal part of the arch: from the stem of the aortic sac.
• Middle part: from the left horn of the aortic sac.
• Distal part: from the left 4th arch & left dorsal aorta
down to the origin of 7th cervical inter-segmental artery (LT subclavian
artery).
– The adult descending aorta: from the left dorsal aorta, caudal to the
origin of the 7th cervical intersegmental artery, while the right dorsal aorta
degenerates.
• Aortic anomalies:
1- Coarctation of aorta: the aortic lumen is significantly narrow below
the origin of the left subclavian artery, it affects the blood supply of LL.
2- Abnormal origin of right subclavian artery: The right subclavian arise
from persistent distal part of right dorsal aorta.
3- Double aortic arch: persistent both distal part of right dorsal aorta &
right 4th aortic arch. The second component of the aortic arch passes
behind the esophagus causes difficulty in swallowing and respiration.
 Development of veins
- In a 4th weeks embryo, three paired veins open into the tubular heart:

1- Vitelline veins, returning

deoxygenated blood from the
yolk sac

2- Umbilical veins, bringing

oxygenated blood from the
placenta.

3- Cardinal veins, returning

deoxygenated blood from the
body of the embryo

Vitelline Veins

- Pass through the septum transversum and drain into the sinus venosus

- In relation to the developing liver within the septum transversum, the

vitelline veins are divided into:

♥ Pre-hapatic part: forms anastomosis around the duodenum which later on

gives rise to the portal vein

♥ Hepatic part: interrupted by the liver cords, forms an extensive vascular

network called the hepatic sinusoides

♥ Post-hepatic part: left vein disappears but right vein forms the:

Hepatic veins and hepatic segment of inferior vena cava

Umbilical Veins

- Carry oxygenated blood from the placenta

- Initially run on each side of developing liver and drain into sinus venosus

- As the liver grows, the umbilical veins loose their connection with heart
and open into the liver.

- The right vein disappears by the end of the embryonic period. The left
vein persists.

- A wide channel (ductus venosus), appears through the substance of liver

to connect the left umbilical vein with the inferior vena cava

- After birth:

- The left umbilical vein obliterate to form the ligamentum teres of the liver

- The ductus venosus obliterate to form the ligamentum venosum

Cardinal veins:
• They are longitudinal veins, mesodermal in origin, symmetrical on both
side of the body& drain the body of embryo.
• They developed gradually: anterior, posterior & common cardinal veins
developed earlier than supra-cardinal & sub-cardinal veins
• Anterior cardinal veins: Present cranial to the heart level, drain head &
UL buds.
• Posterior cardinal vein: caudal to the heart level, drain trunk & LL buds.
• Common cardinal vein: two short venous channels formed by union of
anterior & posterior cardinal veins, they drain into the sinus venosus.
• Sub-cardinal vein: Present caudal to the heart level, ventro –medial to
the mesonephric ridge.
• Supra-cardinal vein: Present caudal to the heart level, dorso-lateral to
the dorsal aorta.
– Both subcardinal & supracrdinal veins gradually replace the posterior
cardinal.

- Fate of cardinal veins:

The cardinal vein Right side Connecting Left side
segment
Anterior cardinal - Rt. Internal jugular - Lt. Internal jugular
Vein vein. vein.
- Rt. Innominate vein. - Lt. innomenate vein.
- Upper half of SVC
posterior cardinal vein Degenerates _________ degenerates
Common cardinal vein - Lower half of SVC __________ - Oblique vein of the
_ right atrium
Sub-cardinal vein - Rt. Suprarenal vein. - Lt. renal -Lt. Suprarenal vein.
- IVC. vein - Lt. Gonadal vein
- Rt. Gonadal vein.
Supra-cardinal vein Azygos vein __________ - Superior & inferior
_ hemi-azygos veins
Adult IVC: it is derived from: (Caudal to cranial):
– Lower most part of right posterior cardinal vein (called sacro-cardinal
vein).
– Right subcardinal vein.
– Connecting anastmotic segment with hepato-cardiac channel.
– Hepato-cardiac channel (Right vitelline vein).
Anomalies of SVC:
1- Left SVC: due to persistent anterior cardinal vein on the left side
while it is obliterated on the right side.
2- Double SVC: due to persistent anterior cardinal vein on the both
right & left sides.
Anomalies of IVC:
1- Double IVC: Due to persistent both right & left sacro-cardinal veins.
2- Absent IVC: Due to absent connecting segment with the hepatocardiac
channel. The right subcardinal vein ends into the supracrdinal (azygos)
vein.