EMBRYOLOGY OF THE CARDIOVASCULAR SYSTEM

Achmad aminuddin

ESTABLISHMENT OF THE CARDIOGENIC FIELD

THE VASCULAR SYSTEM APPEAR IN THE MIDDLE OF THE THIRD WEEK. CARDIAC PROGENITOR CELLS LIE IN THE EPIBLAST LATERAL TO PRIMITI VE STREAK. CELLS MIGRATE TOWARD ROSTRAL TO THE BUCCOPHARYNGEAL MEMBR BRANE AND NEURAL FOLDS, IN THE SPLANCHNIC LAYER OF THE LATERAL PLATE MESODER. THEY ARE INDUCE BY THE UNDERLYING PHARYNGEAL ENDODERM TO FORM CARDIAC MYOBLAST. BLOOD ISLANDS APPEAR IN THIS MESODERM. THE ISLANDS UNITE TO FORM A HORSESHOE-SHAPED ENDOTHELIAL-LINED TUBE SURROUNDED BY MYOBLAST IS KNOWN AS CARDIOGENIC FIELD THE INTRAEMBRYONIC CAVITY DEVELOP INTO PERICARDIAL CAVITY. BLOOD ISLANDS APPEAR TO FORM THE DORSAL AORTAE.

FORMATION AND POSITION OF THE HEART TUBE

FORMATION AND POSITION OF THE HEART TUBE

THE RESULT OF GROWTH OF THE BRAIN AND CEPHALIC FOLDING, THE BUCCOPHARYNGEAL MEMBRANE IS PULLED FORWARD, THE HEART AND PERICARDIAL CAVITY MOVE TO CERVIX THEN TO THE THORAX. THE RESULT OF THE EMBRYO FOLDS IS THE CAUDAL REGION OF THE PAIRED CARDIAC PRIMORDIA MERGE EXCEPT AT THEIR CAUDAL MOST ENDS. THE CRESCENT PART OF THE HORSESHO- SHAPED AREA EXPANDS TO FORM THE FUTURE OUTFLOW TRACT AND VENTRICLE THE HEART BECOMES A CONTINUOUS EXPADED TUBE, AND RECEIVES VENOUS DRAINAGE AT IT CAUDAL POLE AND BEGINS TO PUMP BLOOD OUT OF THE FIRST AORTIC ARCH INTO THE DORSAL AORTA. THE DEVELOPING HEART TUBE BULGES IN TO THE PERICARDIALCAVITY, AND ATTACHED TO THE DORSAL SIDE - DORSAL MESOCARDIUM . PROEPICARDIUM FORM MOST OF THE EPICARDIUM.

FORMATION OF THE CARDIAC LOOP

ON DAY 23 HEART TUBE , CEPHALIC PORTION BEND VENTRAL LY, CAUDALLY AND TO THE RIGHT , CAUDAL PORTION ( ATRIUM ) SHIFTS DORSOCRANIALLY AND TO THE LEFT IT IS COMPLETE BY DAY 28. ATRIAL PORTION FORM A COMMON ATRIUM. ATRIOVENTRICULAR JUNCTION FORM THE ATRIOVENTRICULAR CANAL. BULBUS CORDIS WILL FORM THE TRABECULATED PART OF THE RIGHT VENTRICLE. CONUS CORDIS WILL FORM THE OUTFLOW TRAC OF BOTH VENTRICLES. TRUNCUS ARTERIOSUS WILL FORM THE ROOT AND PROX. PART OF THE AORTA AND PULMONARY ARTERY. THE JUNCTION BETWEEN BULBUS CORDIS BULBUS CORDI IS THE PRIMARY INTERVENTRICULAR FORAMEN

DEVELOPMENT OF THE SINUS VENOSUS

IN THE MIDDLE OF THE 4TH WEEK THE SINUS VENOSUS RECEIVE VENOUS BLOOD FROM THE RIGHT AND LEFT SINUS HORN. EACH HORN RECEIVE BLOOD FROM - VITELLINE ( OMPHALOMESENTERIC) UMBILICAL VEIN. - COMMON CARDINAL VEIN. LEFT TO RIGHT SHUNT THE ENTRANCE OF THE SINUS SHIFT TO THE RIGHT. OBLITERATION OF THE RIGHT UMBILICAL AND THE LEFT VITELLINE VEIN ( 5TH WEEK ) THE LEFT SINUS HORN LOSES IT IMPORTANCE.

THE DEVELOPMENT OF THE SINUS VENOSUS

THE LEFT COMMON CARDINAL V IS OBLITERATED AT 10 WEEK ALL THAT REMAINS OF THE LEFT SINUS HORN IS OBLIQUE VEIN OF THE LEFT ATRIUM AND THE CORONARY SINUS. LEFT TO THE RIGHT SHUNT RIGHT SINUS HORN AND VEINS ENLARGE - THE RIGHT HORN FORM THE SMOOTHWALLED PART OF THE RIGHT ATRIUM. SINUATRIAL ORIFICE. SEPTUM SPURIUM. LEFT VENOUS VALVE AND SEPTUM SPURIUM FUSE WITH THE DEVELOPING ATRIAL SEPTUM. THE INFERIOR PORTION OF THE RIGHT VENOUS VALVE FORM THE VALVE OF THE I.V. C. AND THE VALVE OF THE CORONARY SINUS. CRISTA TERMONALIS

FORMATION OF THE CARDIAC SEPTA

FORMED BETWEEN THE 27TH AND 37TH DAYS OF DEVELOPMENT. ENDOCARDIAL CUSHION DEVELOP INTO - ATRIAL AND VENTRICULAR SEPTA. - AV CANAL AND VALVE. - AORTIC AND PULMONARY CHANAL. FORMED BY MERGING OF TWO EXPANDING PORTION OF THE WALL OF THE HEART BUT NEVER COMPLE TELY, ITS USUALLY CLOSED BY NEIGHBOURING PROLIFERATION TISSUE.

CLINICAL CORRELATION
ATRIAL SEPTAL DEFECT. VENTRICULAR SEPTAL DEFECT. TRANSPOSITION OF THE GREAT VESSELS. TETRALOGY OF FALLOT.

SEPTUM FORMATION IN THE COMMON ATRIUM

AT THE END OF THE 4TH WEK IS FORMED SEPTUM PRIMUM AND OSTIUM PRIMUM. OSTIUM PRIMUM IS CLOSED BY ENDOCARDIAL CUSHION AND CELLS DEATH PRODUCES OSTIUM SECUNDUM. APPEAR SEPTUM SECUNDUM WITH OVAL FORAMEN. SEPTUM PRIMUM BECOME VALVE OF THE OVAL FORAMEN. AT BIRTH LUNG CIRCULATION BEGIN AND SEPTUM PRIMUM IS PRESSED AGAINST SEPTUM SECUNDUM OBLITERATING THE OVAL FORAMEN

FURTHER DIFFERENTIATION OF THE ATRIA

PULMONARY VEIN DEVELOP AT THE POSTERIOR LEFT ATRIAL WALL AND GAIN CONNECTION WITH VEINS OF THE DEVELOPING LUNG BUD. THE PULMONARY VEIN AND ITS BRANCHES ARE INCORPORATED INTO THE LEFT ATRIUM, FORMING THE SMOOTH-WALLED PART OF THE ATRIUM. THE TRABECULATED ATRIAL APPENDAGE ARISE FROM THE ORIGINAL EMBRYONIC LEFT ATRIUM. THE RIGHT ATRIAL APPENDAGE ARISE FROM THE ORIGINAL EMBRYONIC RIGHT ATRIUM.

SEPTUM FORMATION IN THE ATRIOVENTRICULAR CANAL

AT THE END OF THE 4TH WEEK APPEAR AV ENDOCARDIAL CUSHION. INITIALLY AV CANAL GIVES ACCESS ONLY TO THE PRIMITIVE LEFT VENTRICLE, AND BY THE DEVELOPMENT OF THE BULBOVENT RICULAR FLANGE SHIFT TO THE RIGHT AND ENLARGEMENT OF THE AV CANAL BLOOD PASSING THROUGH THE AV ORIFICE NOW HAS DIRECT ACCES TO THE PRIMITIVE LEFT AND RIGHT VENTRICLE. THE SUPERIOR AND INFERIOR CUSHIONS PROJECT INTO THE LUMEN AND FUSE LEFT AND RIGHT ORIFICE IS FORMED ( 5TH WEEK )

FORMATION OF THE SEPTUM IN THE AV CANAL

FORMATION OF THE ATRIOVENTRICULAR VALVES

EACH AV ORIFICE IS SURROUNDED BY LOCAL PROLIFERATION OF MESENCHYMAL TISSUE. THE BLOOD STREAM HOLLOWS OUT AND THINS TISSUE. VALVES FORM AND REMAIN ATTACH ED TO THE VENTRICULAR WALL BY MUSCULAR CORD. MUSCULAR TISSUE IS REPLACED BY DENSECONNECTIVE TISSUE. THE VALVE CONSIST CONNECTIVE TISSUE COVERED BY ENDOCARDIUM AND CONNECTED TO THE WALLOF THE VENTRICLE BY PAPILLARY MUSCLES AND CHORDAE TENDINEAE. BICUSPID VALVE FORM IN THE LEFT AV CANAL. TRICUSPID VALVE FORM ON THE RIGHT AV CANAL.

FORMATION OF THE AV VALVES AND CHORDAE TENDINEAE

HEART DEFECTS
ETIOLOGY - COMPLEX INTERPLAY BETWEEN GENETIC AND ENVIRONMENT. - GENETIC FACTOR. - ENVIRONMENTAL AGENTS

CARDIOVASCULAR TERATOGEN
RUBELLA VIRUS. THALIDOMIDE. ISOTRETINOIN ( VITAMIN A ). ALCOHOL. MATERNAL DISEASES - INSULIN- DEPENDENT DIABETES. - HYPERTENSION.

CHROMOSOMAL ABNORMALITY
TRISOMY 18. GENETIC SYNDROME SUCH AS DIGEORGE, GOLDENHAR AND DOWN SYNDROME, MUTATION IN HEART-SPECIFIYING GENE; - NKX2.5, ON CHROMOSOME 5q35, - ASD - TETRALOGY OF FALOT. - A-V CONDUCTION DELAYS. - TBX5 HOLT- ORAM SYNDROME. - LIMB ABNORMALITIES. - A.S.D. - V.S.D.( MUSCULAR PORTION )

ATRIAL SEPTAL DEFECT

OSTIUM SECUNDUM DEFECT excessive cells death and resortion of the septum primum or by inadequate development of the septum secundum COR TRILOCULARE BIVENTRICULRE complete absence of the atrial septum. PREMATURE CLOSURE OF THE OVAL FORAMEN.

ENDOCARDIAL CUSHION
PERSISTEN A-V CANAL combined with atrial and ventricular septal defects. OSTIUM PRIMUM DEFECT usually with a cleft in the anterior leaflet of the tricuspid valves.

TRICUSPID ATRESIA
INVOLVES OBLITERATION OF THE RIGHT A-V ORIFICE. ALWAYS ASSOCIATED WITH ; - PATENCY OF THE OVAL FORAMEN. - VENTRICULAR SEPTAL DEFECT. - UNDERDEVELOPMENT OF THE RIGHT VENTRICLE. - HYPERTROPHY OF THE LEFT VENTRICLE.

SEPTUM FORMATION IN THE TRUNCUS ARTERIOSUS AND CONUS CORDIS

IN THE TRUNCUS, DURING THE 5TH WEEK APPEAR - RIGHT SUPERIOR TRC. SWELLING. - LEFT INFERIOR TRC. SWELLIG GROWING TOWARD THE AORTIC SAC THE SWELLING TWIST AROUND EACH OTHER. after complete fusion the ridge form the AORTICO PULMONARY SEPTUM, dividing truncus into AORTIC AND PULMONARY CHANAL

SEPTUM FORMATION IN THE CONUS CORDIS

IN THE CONUS CORDIS APPEAR - RIGHT DORSAL SWELLING. - LEFT VENTRAL SWELLING. WHEN THE TWO CONUS SWELLING HAVE FUSED, THE SEPTUM DEVIDES THE CONUS INTO - THE OUTFLOW TRACT OF THE R.V. - THE OUT FLOW TRACT OF THE L.V.

THE NEURAL CREST CELLS IN THE HIND BRAIN

ABNORMAL MIGRATION, PROLIFERA TION OR DIFFERENTIATION RESULT - TETRALOGY OF FALLOT. - PULMONARY STENOSIS. - P.D.A. - TRANSPOSITION OF GREAT VESEL

SEPTUM FORMATION IN THE VENTRICLES

BY THE END OF THE 4TH WEEK - GROWTH OF THE MYOCARDIUM WITH DIVERTICULATION AND TRABE CULATION. - THE MEDIAL WALL OF THE EXPAND ING VENTRICLES BECOME APPO SED AND MERGE, forming THE MUSC CULAR INTERVENTRICULAR SEPTUM AND THE INTERVENTRICULAR FORAMEN. - OUT GROWTH OF THE INFERIOR ENDOCARDIAL CUSHION CLOSE THE FORAMEN. - COMPLETE CLOSURE OF THE INTERVENTRICULAR FORAMEN forms THE MEMBRANOUS PART OF THE INTERVENTRICULAR SEPTUM

FORMATION OF THE SEMILUNAR VALVES

WHEN PARTITIONING OF THE TRUNCUS IS ALMOST COMPLETE, PRIMORDIA OF THE SEMILUNAR VALVES BECOME VISIBLE. A THIRD TUBERCLE APPEARS IN BOTH CHANELS OPPOSITE THE FUSED TRUNCUS SWELLINGS. THE TUBERCLES FORMS THE SEMILUNAR VALVES.

VENTRICULAR SEPTAL DEFECT

TETRALOGY OF FALLOT

TRANSPOSITION OF THE GREAT VESSELS

PERSISTENT TRUNCUS ARTERIOSUS

ECTOPIA CORDIS

DEVELOPMENT OF THE ARTERIAL SYSTEM

AORTIC ARCHES during the 4th and 5th week aortic sac form FIVE ARCHES I, II, III, IV, DAN VI. DEVELOPMENT OF THE AORTIC SAC IS FORM ; - THE BRACHIOCEPHALIC ARTERY. - AORTIC ARCH.