Basic Cardiac Embryology & Fetal Circulation

Timeline of Events

Week 3 (21 days) - heart tube forms 23 days- heart beats Week 4 - cardiac loop forms Week 7 - heart fully developed
the 1st organ to fully develop in the fetus resembles adult heart except for foramen ovale

approx. 3wks Heart tube

approx. 4 wks cardiac loop forms

approx. 7 wks fully developed

Primitive Cardiac Tube (bulboventricular tube)

Consists of 6 parts functioning as a tubular pump:

sinus venosus primitive atria primitive ventricle bulbus cordis conus cordis truncus arteriosus

Cardiac Loop

As the tube grows it bends in an anterior & rightward direction forming the bulboventricular loop. Normal looping = dextro or d-looping Abn. looping to left = levo or l-looping

What forms what

Sinus venosus (1) Primitive atria (2)

1 & 2 contribute to SVC, IVC, CS, RA & LA

Atrioventricular canal (3)

large area of connection between primitive atria & ventricle endocardial cushion will form here; will form parts of MV & TV

More...

Primitive ventricle (4) - forms into LV Bulbus cordis: 3 parts

Primitive RV (5) Conus cordis (6) - will form the ventricular outflow tracts (crista supraventricularis) Truncus arteriosus (7) - will form the aorta & pulmonary artery trunk

Aortic arches

6 paired sets of arches form about week 4 These develop into the adult arterial system
3rd set forms common & internal carotid arteries bilaterally 4th develops into aortic arch 6th develops into right & left pulmonary arteries & ductus arteriosus

Septation (septal development)

Atrial septum:
Atrial septum begins from the atrial roof; septum primum & septum secundum separate common atria into rt & lt halves

Endocardial cushions:
divide the AV canal into 2 orifices & parts of MV & TV; help form part of the atrial primum septum & membranous ventricular septum

Valves

AV valves (mitral & tricuspid) are formed mainly from the internal ventricular muscular wall Aortic & pulmonic roots are formed from a separation that occurs in the truncus arteriosus. The semilunar valves are formed from small tubercles in the truncus.

Fetal circulation (prenatal)

In the adult, the lungs provide oxygen and CO2 exchange In the fetus, the lungs are basically collapsed & fluid-filled so there is high resistance to blood flow The placenta provides oxygen for the fetus;delivers nutrients & removes wastes

Fetal

Post-natal

Right-sided pressure higher Higher pulmonary resistance 3 shunts exist Placenta provides oxygenated blood IVC blood is O2 rich SVC,CS is O2 poor

Lungs inflate; lowers pulm resistance/ Rtheart pressures Lt-heart press. rises; closes foramen ovale Ductus arteriosus closes w/in 48-72 hrs; becomes ligamentum Ductus venosus closes as flow ceases; becomes ligamentum

Changes at birth

When newborn begins to breathe, the babys body gets higher levels of O2 Pulmonary vascular resistance decreases, blood flow into the lungs increases LAP rises; closes foramen ovale Increases O2 levels, lower vascular resistance closes ductus arteriosus

Continued..

Clamping umbilical cord ends placental function; closes umbilical vein & ductus arteriosus
In premature infants, PFO & PDA are common

Key to diagram
1. Aortic arch 2. Ductus arteriosus 3. Pulmonary trunk 4. Pulmonary veins 5. LA 6. SVC 7. Foramen ovale 8. RA 11. Portal sinus 12. Portal vein 13. Umbilical vein 14. Umbilical arteries 15. Placenta 16. Descending aorta

9. IVC
10. Ductus venosus

Sources

CV Principles: A Registry Prep, Reynolds Echocardiography, 2nd edition, Allen Textbook of Diagnostic Ultrasound, 5th edition, Hagan-Ansert DeWitt Feigenbaums Echocardiography, 6th edition.