Cardiovascular system

Objectives
• By the end of the lecture you should be able to:
• Describe the formation, site, union, division of the of the heart tube.
• Describe the formation and fate of the sinus venosus.
• Describe the formation of the interatrial and the interventricular septa
• Describe the formation of the two atria and the two ventricles.
• Describe the partitioning of the truncus arteriosus and formation of the aorta and
pulmonary trunk.
• List the most common cardiac anomalies.
Establishment and patterning of the primary
heart field
• The vascular system appears in the
middle of the third week, when the
embryo is no longer able to satisfy
its nutritional requirements by
diffusion alone.

• Also , it is the first major system to

function within the embryo and the
heart beginning to function during
the fourth week.
 Primary heart field (PHF)
• The Progenitor heart cells Primary
• lie in the epiblast, immediately heart field
adjacent to the cranial end of the
primitive streak.

• migrate through the streak and into

the visceral layer of lateral plate
mesoderm.
• They form a horseshoe-shaped Primary heart field
cluster of cells called the primary
heart field (PHF) cranial to the neural
folds .

• PHF form portions of the atria and

the entire left ventricle.
 Seconary heart field (SHF)
• appears slightly later than those in
the PHF(days 20-21).

• responsible for formation of the

remainder of the heart (part of right
ventricle, outflow tract-conus cordis
and truncus arteriosus).

• resides in splanchnic mesoderm

ventral to the posterior pharynx.
 Primary Secondary
heart field heart field

A. Dorsal view of a late presomite embryo [approximately 18 days] after removal of the amnion.
Progenitor heart cells have migrated and formed the horseshoe—shaped PHF located in the
splanchnic layer of lateral plate mesoderm. As they migrate, PHF cells are specified to develop the left
and right sides of the heart, including the left ventricle [LV] and parts of both atria [A]. The right
ventricle [RV], outflow tract [conus cordis [C] and truncus arteriosus [T]], and remainder of both atria
also exhibit left—right patterning and are formed by the SHF.
• PHF are induced by the underlying pharyngeal endoderm to form cardiac
myoblast and Blood islands that will form blood cells and vessels by the process of
vasculogenesis.

B. Transverse section through a similar—staged embryo to show the position of

PHF cells in the visceral mesoderm layer.
• With time, the islands unite and form a horseshoe-shaped endothelial-lined
tube surrounded by myoblasts. This region is known as the cardiogenic field.
• Initially , the central portion of
the cardiogenic area is anterior
to the oropharyngeal
membrane and the neural
tube.

• the intraembryonic cavity over

it later develops into the
pericardial cavity.
Formation and Position of the Heart
Tube
• With closure of the neural tube and
formation of brain vesicles, the central
nervous system grows cranially so
rapidly that it extends over the central
cardiogenic region and the future
pericardial cavity.

• As a result of growth of the brain and

cephalic folding of the embryo, the
oropharyngeal membrane is pulled
forward, whereas the heart and
pericardial cavity move first to the
cervical region and finally to the
thorax.
• As the embryo grows and bends cephalocaudally ,it also folds laterally.
• the caudal regions of the paired cardiac tube merge except at their caudal most
ends.
• Thus the heart becomes a continuous expanded tube consisting of an inner
endothelial lining and an outer myocardial layer.
• It receives venous drainage at its caudal pole and begins to pump blood out of the
first aortic arch into the dorsal aorta at its cranial pole.
 The heart tube
• The heart tube consists of:
• (1)Endocardium: forming the internal
endothelial lining of the heart.

• (2)myocardium: thickens and secretes a

thick layer of extracellular matrix, rich in
hyaluronic acid, that separates it from the
endocardium. forming the muscular wall.

• (3)epicardium: or Visceral pericardium,

covering the outside of the tube.
While the cardiac loop is forming , local expansions
become visible through out the tube
• Truncus arteriosus.
• Bulbus cordis.
• Primitive ventricle.
• Primitive atrium.
• Sinus venosus.
 Formation of the Cardiac Loop
• The heart tube continues to elongate as
cells are added from the SHF to its cranial
end.

• This lengthening process is essential for

normal formation of the right ventricle
and the outflow tract region (conus
cordis and truncus arteriosus that form
part of the aorta and pulmonary artery
and for the looping process.
 Formation of the cardiac loop
• The atrial portion initially a paired structure outside the pericardial cavity, forms a
common atrium and is incorporated into the pericardial cavity.
• The atrioventricular junction remains narrow and forms the atrioventricular
canal, which connects the common atrium and the early embryonic ventricle .
• The heart tube begins to bend on day 23.
• The cephalic portion of the tube bends ventrally, caudally, and to the right ; and
the atrial (caudal) portion shifts dorsocranially and to the left .
• This bending is completed by day 28.
 Bulbus cordis
• The proximal third will form the trabeculated part of the right ventricle .
• The midportion, the conus cordis, will form the outflow tracts of both ventricles.
• The distal part of the bulbus, the truncus arteriosus, will form the roots and
proximal portion of the aorta and pulmonary artery .
 Development of the sinus venosus
1) At first : sinus venosus opens in
the center of back of the primitive
atrium, and has 2 horns, each horn
receives 3 veins:
• _Common cardinal vein (from the
body wall).

• _Umbilical vein (from the placenta).

• _Vitelline vein (from the yolk sac).

 Development of the sinus venosus
• 2) left- to- right shunt of venous
blood occurs:
• _The right horn enlarges, while the
body and left horn of the sinus diminish
in size.
• _its opening (sinoatrial orifice) will shift
to the right side of the primitive atrium
which will be the right atrium.
• 3) Obliteration of the:
• right and left umbilical veins.
• left vitelline vein
• left common cardinal vein
 Fate of the sinus venosus
• The right horn forms
• Posterior smooth part of right atrium.

• The right common cardinal vein

forms:
• lower part of superior vena cava .

• The right vitelline vein forms:

• opening of the inferior vena cava.

• The diminished body and left horn

forms:
• coronary sinus & oblique vein of the
left atrium.
 Sinuatrial orifice

• The Sinuatrial orifice, is flanked on each side by a valvular fold, the right and left
venous valves .
• Dorsocranially, the valves fuse, forming a ridge known as the septum spurium .
• when the right sinus horn is incorporated into the wall of the atrium, the left
venous valve and the septum spurium fuse with the developing atrial septum.
 Sinuatrial orifice

• The inferior portion develops into two parts:

• (1) the valve of the inferior vena cava and (2) the valve of the coronary sinus .
• The crista terminalis forms the dividing line between the original trabeculated
part of the right atrium and the smooth-walled part, which originates from the
right sinus horn .
 Right Atrium
• The smooth part of the right atrium
is derived from the right horn of the
sinus venosus .
• The rough Trabeculated part of the
right atrium is derived from the
primordial common atrium.
 Left Atrium
• Rough Trabeculated part: derived
from the common primordial atrium.

• The smooth part: derived from the

absorbed Pulmonary Veins.

• The proximal part of these veins is

absorbed into the wall of the
developing left atrium , that’s why
the 4 pulmonary veins open directly
in to the left atrium.
 Formation of cardiac septa
• (1) two actively growing masses
of tissue that approach each
other until they fuse, dividing
the lumen into two separate
canals (A&B)

• (2) a single actively growing cell

mass that continues to expand
until it reaches the opposite
side of lumen (C).

• Such tissue masses are called

Endocardial cushions .
 Endocardial cushions
• Develop in the
1. atrioventricular and
2. conotruncal regions.

• They assist in formation of the

1. atrial and ventricular (membranous
portion) septa.
2. atrioventricular canals and valves
3. aortic and pulmonary channels.
• The septum: is a narrow ridge forms between the two expanding portions of the
wall of the heart. Such a septum partially divides the atria and ventricles and
leaves a narrow communicating canal between the two expanded sections.
• It is usually closed secondarily by tissue contributed by neighboring proliferating
tissues.
 Septum formation in common atrium
• The primitive atrium is divided into right
and left chambers by an inter-atrial
septum.
• A) Septum primum :
• a sickle-shaped crest grows from the
roof of the common atrium into the
lumen.
• extend toward the endocardial cushions
in the atrioventricular canal.
• The opening between the lower rim of
the septum primum and the endocardial
cushions is the (ostium primum).
• An extension is growing from the
endocardial cushions, closing the
ostium primum, but before that , anew
opening appears in the upper portion
of septum primum , that is ostium
secundum.
• _Later , anew septum develops to the
right of septum primum , that is
septum secundum.

• B) Septum secundum:
• _ it is also crescentic membrane .it
develops just to the right side of
septum primum .
• When the left venous valve and the septum spurium fuse with the right
side of the septum secundum, the free concave edge of the septum
secundum begins to overlap the ostium secundum.

• The opening left by the septum secundum is called the oval foramen
(foramen ovale).
_When the upper part of the septum primum gradually disappears, the remaining
part form the valve of the oval foramen.
 Fate of foramen ovale
• After birth
• when lung circulation begins and pressure in the left atrium increases, the valve
of the oval foramen is pressed against the septum secundum, obliterating the
oval foramen and separating the right and left atria.

• In about 20% of cases, fusion of the septum primum and septum secundum is
incomplete, and a narrow oblique cleft remains between the two atria. This
condition is called probe patency of the oval foramen; it does not allow
intracardiac shunting of blood.
Septum formation in the 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.
 Atrioventricular valves
• Two valve leaflets, constituting the
bicuspid (or mitral)valve, form in
the left atrioventricular canal .

• and Three , constituting the

tricuspid valve, form on the right
side.

• they are connected to thick

muscular trabeculae in the wall of
the ventricle ,the papillary muscles ,
by means of chordae tendineae .
 Septum formation in the ventricles
• The medical wall of the expanding
ventricles forming the muscular
interventricular septum.
• The interventricular foramen , above
the muscular portion of the
interventricular septum
• after out growth of tissue from the
endocardial cushion along the top of the
muscular interventricular septum closes
the foramen.
• Complete closure of the interventricular
foramen forms the membranous part of
the interventricular septum.
Septum formation in the truncus arteriosus
and conus cordis
• pairs of opposing ridges appear in
the truncus arteriosus .
• These ridges, the truncus swellings,
or cushions, lie on the right
superior wall (right superior truncus
swelling) and on the left inferior
wall (left inferior truncus swelling) .
• The right superior truncus swelling
grows distally and to the left, and
the left inferior truncus swelling
grows distally and to the right.
• Hence, while growing toward the aortic sac, the swellings twist around each
other, foreshadowing the spiral course of the future septum .
• After complete fusion, the ridges form the aorticopulmonary septum, dividing
the truncus into an aortic and a pulmonary channel.
• When the truncus swellings appear,
similar swellings (cushions) develop along
the right dorsal and left ventral walls of
the conus cordis .
• The conus swellings grow toward each
other and distally to unite with the
truncus septum.
• When the two conus swellings have
fused, the septum divides the conus into
an anterolateral portion (the outflow tract
of the right ventricle) and a posteromedial
portion (the outflow tract of the left
ventricle) .
• The bulbus cordis 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.
 The role of neural crest cells
• Originating from the hindbrain region,
migrate through pharyngeal arches 3,
4, and 6 to the outflow region of the
heart, which they invade .
• In this location, they contribute to
endocardial cushion formation in both
the conus cordis and truncus
arteriosus.
• Therefore, outflow tract defects may
occur by insults to the SHF or insults
to cardiac neural crest cells that
disrupt formation of the conotruncal
septum.
 Atrial Septal Defects (ASD)

Absence of Septum Secundum Absence of septum primum and septum

secundum, leads to common atrium.
Excessive resorption of septum primum
(ASD)

Ostium secundum defect caused by excessive resorption of the septum primum.

 Ventricular septal defect (VSD)
• Roger’s disease
• Absence of the membranous part of
interventricular septum.
• Usually accompanied by other
cardiac defects.
 Tetralogy of Fallot
• Tetralogy of Fallot:
• Is the most frequently occurring
abnormality of the conotruncal region,
is due to an unequal division of the
conus resulting from anterior
displacement of the conotruncal
septum.
• It is a cyanotic disease of the new
born.
 Tetralogy of fallot
• Displacement of the septum produces
four cardiovascular alterations:

• 1-narrow right ventricular outflow

region, pulmonary infundibular
stenosis.
• 2-VSD
• 3-overriding aorta
• 4-hypertrophy of the right ventricular
wall.
(TGA) or transposition of great arteries
• TGA is 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.
• It is one of the most common
cause of cyanotic heart disease in
the newborn.
• Often associated with ASD or VSD.
 Persistent Truncus Arteriosus
• results when the conotruncal ridges
fail to form such that no division of the
outflow tract occurs.
• It is usually accompanied with VSD.
Thank you