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Download 12-Development_of_Heart
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Dr. Ahmed Fathalla Ibrahim EARLY DEVELOPMENT OF HEART • Splanchnic mesenchymal cells aggregate in cardiogenic area to form two angioblastic cords • Cords canalize to form two endocardial heart tubes • After folding: 1. The 2 tubes approach each other & fuse (cranio-caudally) to form a single heart tube 2. The heart tube becomes caudal to oropharyngeal membrane EARLY DEVELOPMENT OF HEART EARLY DEVELOPMENT OF HEART The heart tube elongates & forms: 1. Truncus arteriosus 2. Bulbus cordis 3. Ventricle 4. Atrium 5. Sinus venosus EARLY DEVELOPMENT OF HEART • The trucus arteriosus is continuous cranially with aortic sac from which aortic arches arise • The sinus venosus lies in the septum transversum & receives umbilical, vitelline & common cardinal veins So: • The arterial & venous ends of heart are fixed by pharyngeal arches & septum transversum, respectively EARLY DEVELOPMENT OF HEART • The bulbus cordis & ventricle grow faster than atrium & sinus venosus: 1. The heart bends upon itself forming a U-shaped loop 2. The atrium and sinus venosus become dorsal 3. A track is formed between arterial & venous end (transverse pericardial sinus) after degeneration of dorsal mesocardium PARTITIONING OF ATRIOVENTRICULAR CANAL PARTITIONING OF ATRIOVENTRICULAR CANAL • At the end of 4th week, 2 mesenchymal thickening (endocardial cushions) form on the dorsal & ventral walls of atrioventricular canal • The 2 dorsal & ventral cushions fuse & divide AV canal into right & left canals • The 2 cushions contribute to the formation of: 1. AV valves 2. Membranous part of interventricular septum PARTITIONING OF PRIMORDIAL ATRIUM PARTITIONING OF PRIMORDIAL ATRIUM PARTITIONING OF PRIMORDIAL ATRIUM • Septum primum: a crescent-shaped septum arises from the roof of the atrium & grows toward the endocardial cushions. • Foramen primum: an opening between edge of septum primum & cushions. It disappears when septum primum fuses with cushions PARTITIONING OF PRIMORDIAL ATRIUM • Foramen secundum: formed by fusion of many perforations appearing in the central part of septum primum • Septum secundum: a crescent-shaped septum arises from the roof of atrium to the right of septum primum & overlaps foramen secundum PARTITIONING OF PRIMORDIAL ATRIUM • Foramen ovale: a defect between primary & secondary septum that allows passage of most of oxygenated blood from right to left atrium. Later on, the cranial part of septum primum degenerates & its remaining part forms a valve for the oval foramen preventing the passage of blood in the opposite direction PARTITIONING OF PRIMORDIAL ATRIUM AFTER BIRTH: • Due to equalization of pressure on both atria, the foramen ovale closes & both septa fuse to form the interatrial septum • Fossa ovalis: remnant of septum primum (valve of foramen ovale), marks site of foramen ovale • Annulus ovalis: remnant of septum secundum CHANGES IN SINUS VENOSUS CHANGES IN SINUS VENOSUS • Initially, sinus venosus opens into the atrium & is formed of 2 equal horns • Right horn: enlarges & becomes incorporated in the wall of right atrium • The valve between right horn & right atrium: its cranial part forms crista terminalis; its caudal part forms valves of IVC and coronary sinus CHANGES IN SINUS VENOSUS • The valve between left horn & left atrium: forms part of interatrial septum • Left horn: remains small & forms the coronary sinus Primordial pulmonary vein Primordial pulmonary vein • Develops as an outgrowth of dorsal atrial wall, to the left of septum primum • Divides into two branches then into 4 branches • As atrium expands, the stem of pulmonary vein & its main branches are gradually incorporated into the wall of left atrium SUMMARY OF DEVELOPMENT OF RIGHT ATRIUM • • • • • Muscular part: primordium atrium Smooth part: right horn of sinus venosus Fossa ovalis: part of septum primum Annulus ovalis: part of septum secundum Crista terminalis: cranial part of right sinuatrial valve • Valves of IVC & coronary sinus: caudal part of right sinuatrial valve • Interatrial septum: fused septum primum & secundum + left sinuatrial valve • Coronary sinus: left horn of sinus venosus SUMMARY OF DEVELOPMENT OF LEFT ATRIUM • Left auricle: primordium atrium • Rest of left atrium (smooth part): stem of pulmonary vein & its main branches PARTITIONING OF PRIMORDIAL VENTRICLE PARTITIONING OF PRIMORDIAL VENTRICLE • Muscular part of interventricular septum: a crescentic fold with a concave cranial edge arises from the floor of ventricle (near its apex) & grows toward fused endocardial cushions PARTITIONING OF PRIMORDIAL VENTRICLE • Interventricular foramen: an opening between muscular part of septum & cushions. It is closed (7th week) as a result of fusion of : right & left bulbar ridges + endocardial cushions PARTITIONING OF PRIMORDIAL VENTRICLE • Membranous part of interventricular septum: derived from an extension from right side of endocardial cushion PARTITIONING OF BULBUS CORDIS & TRUNCUS ARTERIOSUS PARTITIONING OF BULBUS CORDIS & TRUNCUS ARTERIOSUS • During 5th week, mesenchyme derived from neural crest cells proliferate to form bulbar & truncal ridges that are continuous with each other • Ridges are spirally oriented • Bulbus cordis is divided into conus arteriosus (infundibulum) & aortic vestibule • Truncus arteriosus is divided into: pulmonary trunk & ascending aorta SUMMARY OF DEVELOPMENT OF RIGHT VENTRICLE • Muscular part: primordium ventricle • Infundibulum: bulbus cordis SUMMARY OF DEVELOPMENT OF LEFT VENTRICLE • Muscular part: primordium ventricle • Aortic vestibule: bulbus cordis DEVELOPMENT OF VALVES • Develop as swellings arising from localized proliferations of tissue: 1. Around AV canals (AV valves) 2. Around orifices of aorta & pulmonary trunk (semilunar valves) • Swellings are hollowed out & reshaped to form the cusps CONGENITAL HEART DEFECTS • Are common (0.6 -0.8%) • Caused by genetic abnormalities, rubella virus or by environmental factors • Some are with unknown cause DEXTROCARDIA • • • • Most frequent positional abnormality Cause: heart tube bends to the left Results: heart is displaced to the right Occurrence: isolated or with situs inversus ATRIAL SEPTAL DEFECT • More frequent in females • Most common form: patent foramen ovale (due to incomplete adhesion between septum primum & secundum) ATRIAL SEPTAL DEFECT • Other forms: 1.Ostium secundum defect: due to defect in one or both septa 2.Endocardial cushions defects with ostium primum: septum primum does not fuse with cushions resulting in a patent forament primum 3.Sinus venosus defect: incomplete absorption of sinus venosus 4.Common atrium: failure of both septa to develop VENTRICULAR SEPTAL DEFECT • Most common type of congenital heart diseases 1. Membranous VSD (most common): incomplete closure of IV foramen due to failure of membranous part of septum to develop 2. Muscular VSD 3. Common ventricle: absence of whole IV septum ECTOPIA CORDIS • Very rare • Heart is partly or completely exposed on the surface of thorax • Usually associated with separated halves of sternum & open pericardial sac • Cause: faulty development of sternum & pericardium due to failure of complete fusion of lateral folds in formation of thoracic wall