CARDIOVASCULAR SYSTEM
DR AQSA, DEPARTMENT OF EASTERN MEDICINE
AND SURGERY, 7 MAY 2025
CARDIOVASCULAR SYSTEM
■The cardiovascular system is one of
the first body systems to appear
within the embryo. It is active by the
beginning of the fourth week
Primitive Heart Tube
■ The development of the heart begins with the formation of
the primitive heart tube following the folding of the embryo
during the end of the third week.
■ Firstly, lateral folding creates the heart tube by bringing
together two precursor regions, then cephalocaudal folding
positions the heart tube in the future thorax. Initially, the
heart tube is suspended within the pericardial cavity by a
membrane; this subsequently degenerates to allow for
further growth.
■ From superior to inferior, the primitive heart tube is
comprised of six regions:
■ Aortic roots (Arterial poles)
■ Truncus arteriosus
■ Bulbus cordis
■ Ventricle
■ Atrium
■ Sinus venosus (Venous poles)
■ The heart tube continues to elongate, and begins looping at
around day 23 of development. The bulbus cordis moves
ventrally, caudally, and to the right (forward, down and right),
and the caudal portion – the primitive ventricle –
moves dorsally, cranially and to the left (backwards, up and
left).
■ This process produces a shape that is much closer to the
fully developed heart.
Atria
■ At the fourth week, the sinus venosus is responsible for the
inflow of blood to the primitive heart, and empties into
the primitive atrium. It receives venous blood from the right
and left sinus horns.
■ In the left atrium, a similar process occurs with
the pulmonary veins. The four pulmonary veins are
incorporated into the left atrium, forming the smooth inflow
portion of the left atrium and the oblique pericardial sinus.
Aortic Arches
■ The early arterial system begins as a bilaterally symmetrical
system of arched vessels, which then undergo
extensive remodeling to create the major arteries that exit the
heart.
Septation of the Heart
■ Septation of the heart into right and left channels occurs first,
when endocardial cushions developing in the atrioventricular
region expand to divide the heart.
■ Atrial
■ The septation of the primitive atrium involves the formation of
two septa and three ‘holes’.
■ Firstly, the septum primum forms and extends down towards the
fused endocardial cushions to split the atrium into two. The ostium
primum is a hole present before the septum primum completes fusion with
endocardial cushions. Before the ostium primum is closed a second hole,
the ostium secundum, appears within the septum primum.
■ Following this a second septum, the septum
secundum, grows with a hole known as the foramen
ovale present. The presence of both the ostium
secundum and foramen ovale allows a right to left
shunt to be present in the developing heart.
■ The timing of this process is carefully controlled. At all
times, at least one hole is present in the septa to allow
communication between the left and right atria. This
allows blood to be shunted to the left side of the heart,
bypassing the non-functional lungs.
Ventricular
■ The interventricular septum of the ventricles has two
components; one muscular and one membranous.
■ The muscular portion forms much of the septum and grows
up from the floor of the ventricles towards the
fused endocardial cushions, but a small gap, the primary
interventricular foramen, remains.
■ This gap is filled by the membranous portion of the
interventricular septum, which is comprised of connective
tissue derived from endocardial cushions.
Outflow Tract
■ Endocardial cushions also appear within
the truncus arteriosus which grow towards
each other.
■ As they grow towards each other they twist
around each other and form a spiral
septum, dividing the outflow tract into left
and right sides.
■ Tetralogy of Fallot is a congenital heart defect in which there
are four abnormalities found:
■ Overriding aorta– an aorta that is connected to both the left
and right ventricles
■ Pulmonary stenosis– a narrowing of the right ventricular
outflow tract
■ Ventricular septal defect– failure of the interventricular
septum to fully close
■ Right ventricular hypertrophy– the right ventricle is more
muscular than normal
■ It is the most common cyanotic congenital heart defect and
is often diagnosed prenatally using echocardiography.
■ Treatment takes the form of surgery during the first
year of life, in which the pulmonary valve can
be widened and the ventricular septal defect
repaired. If the condition is not treated, Tetralogy of
Fallot results in progressive worsening of the right
ventricular hypertrophy, eventually leading to heart
failure.
Thank you
