EMBRYOLOGY OF HEART AND

FOETAL CIRCULATION

Dr. Ravi Gadani

 Retrospect…
 Starting point is the formation of the trilaminar
embryo, that is, a flat embryo with three germ
layers –
 Ectoderm, Mesoderm and Endoderm.
 At the extreme head end of the embryo the
ectoderm and endoderm are in contact without
intervening mesoderm. This area is called the
prochordal (“in front of the notochord”) plate.
 The lateral plate mesoderm splits to form the
coelomic cavity. Further, the head and tail ends of
the embryo undergo folding. The embryo also folds
on the sides (lateral folds).
 Folding of the embryo converts it from a flat plate
Earliest Development of
circulatory system
1. Blood islands
2. Formation of heart tube
3. Vascular circuits
A) Blood islands
 Cardiovascular system makes its first
appearance while the embryo is still flat.
-3weeks of gestation
 Clusters of mesodermal cells specialize to
form blood cells. Mesodermal cells
around these flatten to form endothelium
of blood vessels.

 These clusters are called blood islands of

angiogenic (“blood vessel-forming”) cell
clusters.- angioblastic blood islands
 A mass of H
mesoderm, called
cardiogenic area,
near the head end
(H) will give rise to
the heart.
 The sagittal section

below illustrates the Prochordal plate

three germ layers,
prochordal plate and
Cardiogenic area
the cardiogenic area.
Head Fold
With the formation of the head fold (shown
in the blue circle), note how the
cardiogenic area changes its position.
Also observe that the endoderm
(yellow) is beginning to form the gut
tube. At this stage only the head and
tail ends of the digestive tube are
recognisable.
In the lowest picture, the gut tube is better
seen and the heart is in fact in the form
of a tube (red).

Heart Tube
B)Formation of heart tube
 Middle of the third week of gestation
angioblastic blood islands form a plexus
of vessels lying deep to the
horseshoe-shaped
prospective pericardial cavity.
 These small vessels develop into paired
endocardial heart tubes.
 The splanchnic mesoderm proliferates
and develops into the myocardial
mantle which gives rise to the
myocardium. The epicardium develops
 The bilateral endocardial heart tubes continue to
develop and connect with a pair of vessels, the
dorsal aortae, located on either side of the
midline.
 They fuse in the midline as a single
endocardial heart tube. The endocardial heart
tube is surrounded by the myocardial mantle and
between these two layers is the cardiac jelly.
 The resulting heart tube is suspended in the
pericardial cavity
 When the single heart tube is formed, the
embryo is in the fourth week of gestation, is
about 3 mm in length, and the neural tube is
 The Heart Tube

 The tail end is the venous

end and the cranial end is
the arterial end.

Heart
Liver
 Remember that the tube is
not partitioned at this stage.
C. Vascular Circuits
 As the heart begins to beat three sets of blood
islands coalesce to form three vascular circuits
 Embryonic circuit and two extraembryonic circuit.
 Embryonic circuit:
 It consists of paired dorsal aortae that arise

from the endocardial heart tube and break up

into capillary network that supply blood to the
developing embryonic tissues.

 Blood is drained from these tissues by

anterior and posterior cardinal veins that
drain into common cardinal veins, which in turn
drain into the endocardial heart tube.
Extraembryonic circuits

 Vitelline (omphalomesenteric, yolk

sac) circuit.
 blood from the dorsal aortae drain into
vitelline arteries that in turn supply the yolk
sac.
 The blood drains back to the heart tube via
paired vitelline veins.
 Umbilical (allantoic, placental)
circuit.
 the dorsal aortae supply blood to umbilical
arteries that in turn bring this now
unoxygenated blood back to the placenta.
Formation of the Primitive Four
Chambered Heart.
 As the endocardial heart tubes fuse, several
bulges and sulci appear.
 From the cephalic end, the bulges are the
bulbus cordis (truncus arteriosus and the co
nus arteriosus)
, the primitive ventricle, the primitive atrium
and the sinus venosus. The veins connect to
the heart tube via the sinus venosus,
 the paired dorsal aortae arise from aortic
arches that in turn arise from the aortic sac.
The aortic sac is at the most cephalic end of the
bulbus cordis.
 The sulci present are the bulboventricular
The Tube Bends

V B D
A
V SV

The tube, as it grows, cannot be accommodated

within the pericardial cavity and undergoes
bending.
The primitive chambers of the heart are
recognisable, and are labelled in the last picture.

SV – sinus venosus (receives veins from the body), A

– atrium, V – ventricle. The ventricle continues into
the ‘bulbus cordis’which in turn leads to the
Formation of four
chambered heart
The sinus venosus gradually shifts to
the right to empty into the right
atrium.
 The bulboventricular sulcus is

represented inside the heart as the

bulboventricular flange. The
bulboventricular flange and the
muscular interventricular septum
begin to separate the primitive
ventricle (which will become the left
 The atria continue to grow, and bulge
forward on either side of the bulbus
cordis, and shifts the bulbus medially.
 Thus, the primitive four-chambered heart
is formed and blood flows from the veins
to sinus venosus, to atria, to ventricles, to
conus, to truncus, to aortic sac, to dorsal
aorta.
The Chambers

A A

B-V Loop
V

Left view Front view

Recognise the chambers in these two views. In the view from the left side, the
sinus venosus is partly hidden. Note that with the bending of the tube the
atrium is now dorsal and the loop formed by the ventricle and the bulbus
cordis (bulbo-ventricular loop) is ventral.
In the next slide we shall examine the interior of the unpartitioned heart.
Septation of heart
1. Atrial septation
2. Ventricular septation

3. Septation of bulbus cordis

4. Cardiac valve formation

During the second month, the heart

begins to septate into two atria, two
ventricles, the ascending aorta and
the pulmonary trunk.
A)Atrial Septation
 Endocardial cushions develop in the
dorsal (inferior) and ventral (superior)
walls of the heart. These cushions fuse
and divide the common AV canal into the
left and right AV canals.
 At the same time there is a developing
septum from the dorsocranial atrial wall
that grows toward the cushions. This is
the septum primum, and the intervening
space is called the foramen primum.
 As the septum reaches the endocardial
cushions closing foramen primum, a
second opening, foramen secundum
appears in septum primum. As foramen
secundum enlarges, a second septum,
septum secundum forms to the right of
septum primum. Septum secundum
forms an incomplete partition (lying to
the right of foramen secundum) which
leaves an opening, the foramen ovale.
Septum Primum
 This is a sagittal
section seen from
the right.

AVC
V
Passage is a Must!
 Foramen secundum

 Foramen primum
about to disappear
Septum Secundum
 To the right of primum

 Foramen primum has

disappeared
Foramen ovale
 F. Ovale –
 In septum
secundum

 Further…
The ‘Valve’

 Two septa

 Two foramina
Ventricular Septation
 The muscular interventricular (I.V.)
septum grows as a ridge of tissue from
the caudal heart wall toward the fused
endocardial cushions. The remaining
opening is the
interventricular foramen. The IV
foramen is closed by the conal ridges,
outgrowth of the inferior endocardial
cushion, the right tubercle, and
connective tissue from the muscular
interventricular septum. This portion of
Septation of the Bulbus
Cordis
 Truncal swellings (ridges) appear first as
bulges in the truncus on the right
superior and the left inferior walls. They
enlarge and fuse in the midline to form
the truncal (aorticopulmonary) septum.
This septum thus forms the aorta and
the pulmonary arteries.
Cardiac Valve Fromation
 Semilunar valves develop in the aorta
and pulmonary artery as localized
swellings of endocardial tissue.
 The atrioventricular valves develop as
subendocardial and endocardial tissues
and project into the AV canal.
 IVC : Blood
from
placenta
 Ductus
venosus

 F. ovale

 Ductus
arteriosus
Fetal Circulation
 By the third month of development, all
major blood vessels are present and
functioning.

 Fetus must have blood flow to placenta.

 Resistance to blood flow is high in lungs.

Umbilical Circulation
 Pair of umbilical
arteries carry
deoxygenated
blood & wastes
to placenta.
 Umbilical vein
carries
oxygenated
blood and
nutrients from
the placenta.
The Placenta

 Facilitates gas and

nutrient exchange
between maternal
and fetal blood.
 The blood itself
does not mix.
Umbilical vein to portal circulation

 Some blood from the

umbilical vein enters
the portal circulation
allowing the liver to
process nutrients.
 The majority of the
blood enters the
ductus venosus, a
shunt which bypasses
the liver and puts
blood into the hepatic
veins.
foramen ovale
 Blood is shunted
from right atrium to
left atrium,
skipping the lungs.
 More than one-third
of blood takes this
route.
 Is a valve with two
flaps that prevent
back-flow.
Ductus arteriousus

 The blood pumped

from the right
ventricle enters the
pulmonary trunk.
 Most of this blood
is shunted into the
aortic arch through
the ductus
arteriousus.
What happens at birth?
 The change from fetal to postnatal
circulation happens very quickly.
 Changes are initiated by baby’s first
breath.
Foramen ovale Closes shortly after birth,
fuses completely in first
year.
Ductus arteriousus Closes soon after birth,
becomes ligamentum
arteriousum in about 3
months.
Ductus venosus Ligamentum venosum

Umbilical arteries Medial umbilical ligaments

Umbilical vein Ligamentum teres