EMBRYOLOGY

OF
THE HEART

Radityo Prakoso, MD

Division of Pediatric Cardiology and Congenital Heart Disease

Department of Cardiology and Vascular Medicine

Faculty of Medicine University of Indonesia
1.Introduction
2.Development of the Heart Tubes
3.Primitive Heart Looping
4.Atrial Septation
5.Atrioventricular Canal Formation
6.Ventricular Septation
7.Outflow Tract Formation
8.Heart Valves Development
9.Fetal Circulation
Introduction

• Origin : Mesodermal cells

• First 20 days - no cardiovascular structure

• Day 23 - heart tube begins to beat

• Day 30 - blood circulates through the embryo

Development of the Heart
Tube
The first indication of any cardiovascular
development occurs on day 18 or 19

Day 20

Intra embryonic blood vessels are noted

Day 23

Heart tube is complete - begins to beat

 Mesodermal cells

!
Angioblastic cords

(Angiogenic cell clusters)

!
!
4 primitive blood vessels
1 pair at the lateral edge
1 pair more medially

(Lateral Endocardial Tubes)
(Medial Endocardial Tubes)

!
!
Embryo folds

Dorsal aorta
Single heart tube

! !
Fig
the
end
Th
car
dis
lon
sha
thi
sel
asp
pro
tio
Primitive Heart Looping

Due to faster growth of the bulbo-ventricular

portion compared to the pericardial sac and
the rest of the embryo

Day 23

Begins looping

Day 28

Cardiac looping ends, four-chambered heart is
evident
 Atrial Septation

Atrial formation occur during stage of heart looping

No definitive septation

Day 30

Atrial septation begins

(along with atrioventricular canal & ventricle septation)

Day 37

Completed atrial septation
 Important embryologic structure :

• Septum primum

• Ostium primum

• Septum secundum

• Ostium secundum

• Foramen ovale (postnatal : Fossa ovalis)
Atrioventricular canal
formation & septation

5th - 8th week

Origin : Endocardial cushion tissue

Common AV canal - left & right AV canal

Realignment of primitive cardiac chambers
Endocardial cushion tissue
formation
AV canal formation
Realignment of primitive cardiac chambers
Ventricular Septation
Complex Process

Involving different septal structures from various
origins and positioned at various planes

End of 4th week

Primitive interventricular septum - muscular
interventricular septum

Interventricular foramen

(remains open until the end of 7th wk)

Membranous interventricular septum - outflow
tract origins
Muscular part of interventricular
septum
 Membranous part of
interventricular septum
Outflow tract formation
Includes :

Ventricular outflow tract

Aorticopulmonary septum

5th - 7th week

Truncus arteriosus & bulbus cordis

Neural crest cell - bulbar ridges -
aorticopulmonary septum - aorta & pulmonary
artery
Heart Valves Formation
Origin : Subendocardial mesenchymal tissue

!

• Mitral & Tricuspid Valve

• Semilunar valves
Mitral & Tricuspid Valve
 Semilunar Valves

Start to develop just before the completion of the

aorticopulmonary septum
Fetal Circulation
Oxygenated blood

Placenta

V. umbilicalis

Ductus Venosus

V. porta hepatica IVC

 IVC + SVC
O2 SVC < IVC

RA
Mix blood

RV Foramen Ovale

A. pulmonalis 12% lungs PV LA

88% ductus
LV
arteriosus

Ascending aorta

Descending 62% a. carotis, a. 9% a.

aorta subclavia coronaria
 Descending
aorta

Lower body A. Umbilicalis

Placenta
Gas Exchange

Oxygenated blood

Acknowledgement

!
Sesaria Rizky K., MD
Thank you :)