Development of the HEART

Cardiovascular system
Embryology

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 Development of the heart

Objectives
By the end of this lecture the student should be able to:

-Describe the formation, sit, union divisions of the of the heart

tubes.
-Describe the formation and fate of the sinus venosus.
-Describe the partitioning of the common atrium and
common ventricle.
-Describe the partitioning of the truncus arteriosus.
-List the most common cardiac anomalies.

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 Development of the heart

Formation of the heart tube

#The heart is the first functional organ to develop.
#It develops from splanchnic mesoderm in the wall of the yolk
sac.
Cranial to : the developing mouth & nervous system.
Ventral to : developing pericardial sac.
#The heart primordium is first evident at 18 days (as an
angioplastic cords which soon canalize to form the 2 heart
tubes)..
at this stage 2 folding are going to occur: ( Head folding &
Lateral folding )
First: As the head folding complete : the developing heart tubes
lie in the ventral aspect of the embryo dorsal to the developing
pericardial sac (remember that it was on the ventral aspect
before the folding ).
Second : After lateral folding of the embryo : the 2 heart tubes
fuse together to form a single endocardial heart tube within the
pericardial sac. This fusion occurs in a craniocaudal direction
means from above to below.

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 Development of the heart

heart beats begin at 22 to 23 days

blood flow starts at the beginning of 4th week.
( how can we visualize it ? By Ultrasound Doppler )

What is the fate of the heart tube ?

The heart tube grows faster than the pericardial sac, so it
shows 5 alternate dilations separated by constrictions.
These are:
1-Sinus Venosus (most caudal – blood
enter from it )

2-Truncus Arteriosus (most cranial – blood

flow out from it – in the
future it will form the
aorta and pulmonary
trunk )
3-Bulbus Cordis Champers of heart

4-Common
Ventricle
5-Common Atrium.
Form rough atrium
part

As mentioned before, The endocardial heart

tube has 2 ends:
1. Venous end (caudal) Sinus Venosus.
2. Arterial end (cranial)  Truncus arteriosus.

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 Development of the heart

U & S shape heart tubes

First: U shaped heart tube
The cause of the U shape tube formation
is the rapid growth of Bulbus cordis
and ventricle ( number 3 & 4 ) than
the other regions, So the heart Fold
upon itself, forming The U-shaped
heart tube (Bulboventricular loop)

Second: S shaped heart tube

Because of the U shaped tube the the atrium and sinus
venosus (number 1& 5 ) become cranial in position &
dorsal to the truncus arteriosus, bulbus cordis, and
ventricle.

By this stage the sinus venosus has developed 2 lateral

expansions, (Horns) : right and left horns (each horn will
receive 3 veins )

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 Development of the heart

#The three veins are :

1.Common cardinal vein from the fetal body.
2.Vitelline from the yolk sac
3.Umbilical from the placenta. (the only vein have
oxygenated blood)

Fate of Sinus Venosus :

Each part will give rise to different structure :

right horn forms the smooth posterior wall of the right

atrium.
left horn and atrophy and form the coronary sinus.
body
left common forms the oblique vein of the left atrium.
cardinal vein

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 Development of the heart

#Right Atrium
Different parts derived from different

Previous structures :

smooth
posterior part of From the right horn
the right atrium of thevsinus venosus
(RED CIRCLE)
Rough derived from the
Trabeculated primordial common
anterior part atrium.
(musculi pectanti)
(BLUE CIRCLE)

(These two parts are demarcated by the crista terminalis

internally and sulcus terminalis externally)

#Left Atrium

derived from the

smooth part absorbed
Pulmonary Veins
Rough derived from
Trabeculated the common
part primordial atrium

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 Development of the heart

#Partitioning of Primordial Heart:

The partitioning begins by the middle of 4th week. It is completed
by the end of 5th week.
It occurs to 4 different structures :

1-Atrioventricular canal. 3-Common ventricle.

4-Truncus arteriosus
2-Common atrium.
&Bulbus cordis.

First : Partitioning of 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 (RED CIRCLE). Dividing
the AV canal into right & left canals (2 Arrows).
-These canals partially separate the primordial
atrium from the ventricle.

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 Development of the heart

Second: Partition of the Common Atrium:

#Septum Primum
It is sickle- shaped septum that
grows from the roof of the common
atrium towards the fusing
endocardial cushions
(septum intermedium). So, it divides the
common atrium into right & left halves.

#Ostium Primum
-The two ends of septum primum reach to the growing
endocardial cushions before its central part.

-Now the septum primum bounds (surrounds) a foramen

called ostium primum.

*What is the function of this foramen ?

It serves as a shunt, enabling the oxygenated blood to pass

from right to left atrium.*Because the lung is not developed
yet, So the pressure in the right atrium is higher than the left*

-The ostium primum become smaller and disappears as the

septum primum fuses completely with the septum
intermedium to form the AV septum.
Note : THE PARTITION = SEPTUM PRIMUM,

THE FORAMEN = OSTIUM PRIMUM.

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 Development of the heart

#Septum Secundum
On the upper part of septum primum ( The previous partition )
a small openings are

seen and fuse together to form

an opening called Ostium

secundum. This foramen has a

specific septum called septum

secundum ( it descends to the

right side of septum primum).

-It forms an incomplete partition between the two atria.

- Consequently a valvular oval foramen forms, (foramen

ovale).

What is the fate of this Foramen ovale ?

-At birth when the lung circulation begins,

the pressure in the left atrium increases.

-The valve of the foramen ovale is

pressed against the septum secundum

and obliterates the foramen ovale.

-Its site is represented by the Fossa Ovalis

-Its floor represents the persistent part of the septum primum.

-Its limbus (anulus) is the lower edge of the septum secundum.

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 Development of the heart

Third: Partitioning of Primordial Ventricle

The interventricular is divided into (muscular part and
membranous part).

#The Muscular part :

-Division of the primordial ventricle is

first indicated by a median muscular
ridge, the primordial interventricular septum.
-It is a thick crescentic fold which has a
concave upper free edge.
-This septum bounds a temporary connection between the
two ventricles called Interventricular foramen (Because the
muscular part can't reach to the cushions).

#The Membranous part

It is derived from 3 parts :
1- A tissue extension from the right side
of the endocardial cushion.
2- Aorticopulmonary septum.
3- Thick muscular part of the IV septum.
Fourth: Spiral Aorticopulmonary Septum

A spiral septum develops in the truncus arteriosus (number 2

before) dividing it into aorta and pulmonary trunk *that’s why it
is called Aorticopulmonary septum*

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 Development of the heart

-The septum deviates in the lower part of the T A to Right

-It deviates in the middle part Horizontally (dividing TA into
anterior & posterior parts).
-It deviates in the upper part of the TA into Left
This explains the origin of pulmonary trunk from right ventricle
and aorta from left ventricle.
To summarize the course of this septum we can say the it
divides the upper and lower part vertically (Right & Left)
And the middle part horizontally ( Anterior and posterior).

#BULBUS CORDIS

The bulbus cordis forms the smooth upper part of the two
ventricles.
Right Ventricle:
Conus Arteriosus or (Infundibulum) which leads to the
pulmonary trunk.
Left ventricle:
Aortic Vestibule leading to ascending aorta.

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 Development of the heart

~~~ MAJOR CARDIAC ANOMALIES ~~~

We will study 5 anomalies :
# First anomaly : ( ASD ) Atrial Septal Defects :-
It has 4 types :

1 : common atrium : which is Absence

of both septum primum and

septum secundum .

2 : Absence of Septum Secundum •

3 : Large foramen ovale :caused by Excessive resorption

of septum primum .

4 : Patent foramen ovale : (NO CLOSING OF FORAMEN OVALE … COULD BE ASYMPTOMATIC )

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 Development of the heart

#SECOUND anomaly:(VSD) VENTRICULAR SEPTAL DEFECT :-

Roger's Disease : It is absence of the membranous part of intraventricular
septum ( this mean persistent IV foramen )

~ usually accompanied with other cardiac defects .

#Third anomaly : TETRALOGY OF FALLOT :- (tetralogy : complex of

four symptoms ) ((Blue Baby )).

The four symptoms are :

1-VSD

2- Pulmonary stenosis .

3-Overriding of the aorta

4- Right ventricular hypertrophy.

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 Development of the heart

# Fourth anomaly : (TGA) TRANSPOSITION OF GREAT

ARTERIES((Blue Baby )) .
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 causes of cyanotic heart disease in the

newborn.

~ Often associated with ASD or VSD. If not … baby will

die . ( here ASD and VSD useful for baby why ? because it help in mixing
oxygenated blood with non oxygenated )

# Fifth anomaly : Persistent Truncus Arteriosus :-

 It is due to failure of the development of aorticopulmonary (spiral) septum .

 It is usually accompanied with VSD .

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 Development of the heart

Summary

EVENT DATE
Heart primordium 18 days
Heart start to beat 22-23 days
Blood flow during the beginning of the
fourth week

Partitioning of: It begins by the

1- Atrioventricular canal. middle of 4th week.
2- Common atrium. It is completed by
3- Common ventricle. the end of 5th week.
4- Truncus arteriosus
&Bulbus cordis

The ostium primum When the septum primum

become smaller and fuses completely with the
disappears septum intermedium to form
the AV septum.

Fate of foramen Ovale At birth when the lung

circulation begins and the
pressure in the left atrium
increases.

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 Development of the heart

 The heart is the first functional organ to develop. It develops

from splanchnic mesoderm.
 After lateral folding of the embryo the 2 heart tubes fuse
together to form a single endocardial heart tube.
 The endocardial heart tube has 2 ends: Venous end (Sinus
Venosus) and Arterial end (Truncus arteriosus).
 S-Shaped Heart Tube:
* The atrium and sinus venosus become cranial
in position.
 * The sinus venosus has developed 2 lateral expansions, (Horns):
right and left horns.
 The right horn forms the smooth posterior wall of the right atrium.
 The left horn and body atrophy and form the coronary sinus.
 The atrioventricular canals partially separate the primordial
atrium from the ventricle.
 The Septum Primum divides the common atrium into right & left
halves.
 The two atria are separated by incomplete two septums:
Septum Primum and Septum Secundum. They form an
incomplete partition between the atria, this result in the
formation of Foramen Ovale
 Before birth, foramen ovale allows the blood to pass from the
right to the left atrium.
 At birth when the lung circulation begins, the pressure in the left
atrium increases resulting in closure of the foramen ovale.
 There is five major anomalies : 1- ASD . 2-VSD. 3- tetralogy of
fallot. 4- TGA. 5-presistent truncus artriosus .

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 Development of the heart

MCQs :
1*The heart primordium is first evident at:

A.17 days B.18 days C.22-23 days D.24 days

2*Blood flow begins during:

A. beginning of the 4'th week B.End of the 4'th week

C.Middle of the 4'th week

3* Fusion of the two heart tubes occurs in …………… direction :

A. ventrolateral B. Bilateral C. craniocaudal

4*the Vitelline vien drain into Sinus Venosus from ………?

A. fetal body B.placenta C.yolk sac

5*(musculi pectanti) of the right atrium is derived from:

A. primordial common atrium. B. The right horn of the sinus

venosus C. Pulmonary Veins

6*The AV endocardial cushions approach each other and fuse

to form:

A. Septum Primum B. septum intermedium C. ostium

primum
7*…………………..forms an incomplete partition between the
two atria:

A. Septum Secundum B. ostium secondum C. foramen ovale

8* which one forms the smooth posterior wall of right atrium.

A. left horn B. right horn C. left common cardinal

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 Development of the heart

9*the smooth part of left atrium derived from :

A. common primordial atrium B. pulmonary artery C.

absorbed part of pulmonary vein .

10*In what anomaly you can find absence of septum primum

and secundum :

A. patent foramen oval B. large foramen oval C. common

atrium

11*In case of large foramen oval you find :

A. absence of septum primum B. excessive resorption of

septum primum C. excessive resorption of septum secundum

12*which one of the following anomalies can be

Asymptomatic :

A. patent foramen oval B. large foramen oval C.TGA

13*In case of VSD (Roger's disease) Mostly absence of :

A. muscular part of IV septum B. membranous part of IV

septum C. both A and B

14*the fallot's tetralogy is formed of pulmonary stenosis

+overriding of aorta and:

A. VSD + ASD B. right atrium hypertrophy +VSD C. right

ventricular hypertrophy + VSD

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 Development of the heart

15* TGA is due to aorticopulmonary septum :

A. failure of development B. abnormal rotation and formation

C. hypertrophy

Ans.
1.B 2.A 3.C 4.C 5.A 6.B 7.A 8.B
9.C 10.C 11.B 12.A 13.B 14.C 15.B

YouTube Videos :
http://www.youtube.com/watch?v=5DIUk9IXUaI

http://www.youtube.com/watch?v=OArR67aFze0

This work is done by :

Abdulhameed Saeed Alghamdi
Rawan Alotaibi
Sara Alseneidi
Amani Alotaibi
Baraah Alqarni
Noura Alnajashi
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