EMBRYOLOGY OF THE HEART

Blastocyst stage
_____inner cell mass

Two distinct types of cells

______trophoblast

Inner cell mass: forms the embryo

Trophoblast: layer of cells surrounding the cavity which
helps form the placenta

Floats for about 3 days

Implantation on about day 6 post conception
Trophoblast erodes uterine wall
Takes 1 week to complete

Week 2
Inner cell mass divides into
epiblast and hypoblast
2 fluid filled sacs
Amniotic sac from epiblast
Yolk sac from hypoblast

Bilaminar embryonic disc: area

of contact
(gives rise to the whole body)

Week 3

Bilaminar to trilaminar disc

Three primary germ layers: all body tissues develop from these

Ectoderm
Endoderm
Mesoderm

Formation of the 3 germ layers

Primitive streak (groove) on
dorsal surface of epiblast
Grastrulation: invagination of
epiblast cells
Days 14-15: they replace
hypoblast becoming
endoderm
Day 16: mesoderm (a new
third layer) formed
in between
Epiblast cells remaining on
surface: ectoderm

Notochord
Days 16-18
Primitive node epiblast
cells invaginate and
migrate anteriorly with
some endoderm cells
Rod defining the body
axis is formed
Future site of the
vertebral column

 It develops early in the

middle of 3rd week ,
from aggregation of
splanchnic mesodermal
cells, in cardiogenic area
,ventral to pericardial
coelom, and dorsal to
yolk sac.
They form 2 angioblastic
cords that canalize to
form
2
endocardial heart tubes

 After lateral folding of embryo, 2

endocard.tubes fuse to form. Single heart
tube( 21,22 ).
This heart tube lies inside the pericardial
cavity , its dorsal wall is connected to
foregut by dorsal mesocardium (D,22 days).
The central part of dorsal mesocardium
degenerates ,forming transverse passage
dorsal to heart ,called transverse sinus of
pericardium

 Thin endothelial tube becomes internal

endothelial lining of the heart or endocardium.
Splanchnic mesoderm surrounding the pericardial
coelom becomes.. primordial myocardium
(muscular wall of heart).
Thin endothelial tube is separated from thick
muscular tube (myocardium) by gelatinous C.T.
(cardiac jelly). Forming AV septum & valves.

Visceral pericardium is derived from mesothelial

cells and forms the epicardium.

 The primitive heart tube elongates and develops

alternate dilatations and constrictions :

1-truncus arteriosus.
3-primitive ventricle.
5-sinus venosus

2-bulbus cordis.
4-primitive atrium.

 Bulbus cordis &

ventricle grow faster
than other regions, so
the heart bends upon
itself,forming Ushaped
bulboventricular loop
(by the end of 4th
week). The atrium &
sinus venosus also
come to lie dorsal to
truncus arteriosus,
bulbus cordis &
ventricle.

 By the end of 4th

week, unidirectional
blood flow begins at
sinus venosus by
peristalsis- like waves.

Blood passes through

sinuatrial valves into
atrium
Atrioventricular canal
ventricle.. Bulbus
cordis Truncus
arteriosus aortic
sac aortic arches
(arterial channels)
2 dorsal aortae into
body of embryo, yolk
sac , and placenta

 At the end of 4th week, 2 endocardial cushions on

dorsal & ventral walls of atrioventricular canal ,
develop from mesenchymal cells of cardiac jelly.
During 5th week, the AV- endocardial cushions
meet and unite in the middle line to form a
septum and divide the common A-V canal into
right & left A-V canals.

Endocardial cushions also form the AV- valves +

membranous septa of interventricular septum.

PRIMORDIAL ATRIUM
-Septum primum : a thin

crescent-shaped membrane
grows from the roof of
common atrium into the
fusing endocardial cushions
dividing common primitive
atrium into right & left
halves.

-Foramen primum is formed to

pass oxyg.blood from righ to
left atrium. It disapears as
septum primum fuses with
the endocard.cushions
Before closure of foramen
primum , perforations appear
in central part of septum
primium coalesce to form
Foramen Secundum

-Septum secundum :

a crescentic muscular
memb.grows and descends
from roof of atrium during 5th
week. It overlaps foramen
secondum in septum primum
.

The gap between the lower

free border of S.secundum
and the upper edge of
S.primum form foramen
ovale.
Cranial part of S.primum
disappears and remaining
part of S.primum which
attached to endocardial
cushions forms flaplike

valve of the foramen ovale.

SINUS VENOSUS
It consists of body and 2 horns,right &
left.each horn receives 3 veins
1- Vitelline vein from yolk sac.
2- Umbilical vein from placenta,
3-Common cardinal vein from body of
embryo.

left horn & body of

sinus venosus form
the coronary sinus.
left common cardinal
vein becomes small to
form oblique vein of
left atrium.
left vitelline & left
umbilical veins,
degenerate

The right horn becomes absorbed into right

atrium to form its smooth part ,sinus venarum.
- Right vitelline vein becomes IVC.

- Right umbilical vein disapears.

- Right common cardinal vein enlarges to form
SVC.

Primordial muscular
interventricular( IV )septum
arises in the floor of
ventricle , as thick crescentic
fold with concave free edge.
This septum subdivides the
original ventricular cavity
incompletely into right &
left ventricles that
communicate together
through IV foramen.
This foramen closes by the
end of 7th week as the 2
bulbar ridges fuse with the
endocadial cushion.

Sinuatrial (SA) node begins to

develop during 5th w.as it is
present in right wall of sinus
venosus.
SA-node is incorporated into
wall of right atrium with sinus
venosus. SA-node is located
high in the right atrium ,near
entrance of SVC.
Right sinuatrial valve (cranial
part). Forms crista
terminalis,but the caudal part
forms the valves of IVC &
coronary sinus.

Left sinuatrial valve is

incorporated into the
interatrial septum
forming AV-node &
bundle ,which are
located superior to
endocardial cushions.
Right & left bundle
branches arising from
AV-bundle , pass from
atrium into the
ventricular myocardium

CONGENITAL HEART DISEASES

Occurs in 0.5-1% of all live births
Classification :
LR shunts
Cyanotic CHD (RL shunts)
Obstructive lesions

LR Shunts (Acyanotic CHD)

Defects
1.
2.
3.
4.

VSD
PDA
ASD
AVSD (or complete atrioventricular canal)

General Points
PDA & VSD
Presents in infancy
w/ heart failure,
murmur, and poor
growth
Left heart
enlargement (LHE)
Transmits flow and
pressure

ASD
Presents in childhood w/
murmur or exercise
intolerance (AVSD or 1o
ASD presents earlier)
Right heart enlargement
(RHE)
Transmits flow only

Increased PBF

Left Heart
Overload

Right Heart
Overload

Eisenmengers Syndrome
A long standing LR shunt will eventually
cause irreversible pulmonary vascular disease
This occurs sooner in unrepaired VSDs and
PDAs (vs an ASD) because of the high pressure
Once the PVR gets very high the shunt
reverses (ie- now RL) and the patient
becomes cyanotic

RL Shunts
PBF
Truncus arteriosus
Total anomalous pulm.
venous return (TAPVR)
Transposition of the
great arteries (TGA)

PBF
Tetralogy of Fallot
Tricuspid atresia
Ebsteins anomaly

ASD
Accounts about 5%~10% of all CHD cases.
The incidence is estimated to be 1 per 1500
live births.
Is the most common CHD in adult.
Male : Female 1: 2

Classification:
Ostium secundum type
Ostium primum type

Endocardial cushion type

SVC IVC

Oxygenated blood in
PVs
LA

ASD shunting

LV
Aorta Ejection
Systemic circulation
insufficience

Frequent Chest Infection

Congestive CHF

RA enlargement

RV enlargement

PA congestive

Pul. Circulation
congestive
Pul. Arterial
Hypertension

Failure To Thrive