The heart has for centuries

been the fascination of

anatomists, embryologists,
biologists, and physicians.
As the organ most essential
for life, the heart is the first
organ to form in an embryo.
 Pair of valved muscular
pumps combined in a
single organ.
Each pump is
physiologically separate
and interposed in series
at different points in the
double circulation.
 Primordial heart and vascular system appear in
the middle of the third week.
Need for an efficient method of
acquiring oxygen and nutrients from the maternal blood
disposing of carbon-di-oxide and waste products.
 Cardiac progenitor cells - epiblast

signals from the node

induces to form the heart field

Cells migrate craniolaterally

Reside in the splanchnic layer of mesoderm

 Angioblastic cords-
appear in the third week.
Lateral embryonic
folding occurs- heart
tube is formed
Heart begins to beat at
22 to 23 days.
With the formation of the headfold, the
splanchnopleuric mesoderm & the developing
heart come to lie dorsal to the pericardial
cavity & ventral to the foregut
Before the formation of the Formation of folding at
head and tail folds fourth week
Layers of the heart Derived From
Internal endothelial
Endocardium lining

Splanchnic mesoderm
Cardiac jelly
Splanchnic mesoderm
Myocardium
Mesothelial cells arise from the
external surface of the septum
Epicardium transversum and spread over the
myocardium
ARTERIAL POLE AND VENOUS POLE
 The conotruncal
portion of the
heart tube, shifts
gradually to a
more medial
position.
Sinus Venosus
Middle of the fourth
week - recieves venous
blood from the right and
left sinus horns.
Recieves blood from
three important veins:
Vitelline or
omphalomesentric vein
Umbilical vein
Common cardinal vein
 Fifth week
obliteration of the right
umbilical vein and the
left vitelline vein.
Tenth week
obliteration of left
common cardinal vein.
 All that remains of
the left sinus horn
is the
oblique vein of the
left atrium
coronary sinus
 Right sinus horn and
veins enlarge greatly.
Sinus venosus is
incorporated into the
right atrium smooth-
walled part of the right
atrium
 Sinuatrial orifice-
flanked on each side by
valvular fold- the right
and left venous valves
Septum spurium -
valves get fused
dorsocranially
 Inferior portion of the
right venous valve
develops into two parts
Valve of the inferior
venacava
Valve of the coronary
sinus

Crista terminalis

Sulcus terminalis
 End of the fourth week, the primordial atrium is
divided into right and left atria by the formation
and subsequent modification and fusion of two
septa:
Septum primum

Septum secundum
 RIGHT ATRIUM
Original embryonic right
atrium becomes the
trabeculated right atrial
appendage containing
pectinate muscles
Smooth walled sinus
venarum originates from
the right sinus horn
LEFT ATRIUM
Original embryonic left
atrium becomes the
trabeculated left atrial
appendage
Smooth walled part from
the pulmonary veins
 Initially, the AV canal
gives access only to
the primitive left
ventricle and is
separated from the
bulbus cordis by the
bulbo (cono)
ventricular flange.
 Each AV orifice is surrounded by local proliferations of
mesenchymal tissue.
Valves then consist of connective tissue covered by
endocardium.
 Two valve leaflets, constituting the bicuspid (or
mitral) valve, form in the left AV canal, and
three, constituting the tricuspid valve, form on
the right side.
 Septum formation in the Truncus arteriosus
and Conus cordis
 By the end of the
fourth week, the two
primitive ventricles
begin to expand.
Muscular
interventricular
septum.
 System that initiates
and conducts the sinus
impulse.
Central conducting
system- SA node and
AV bundle.
Peripheral conducting
system- Bundle
branches and their
ramifications.
 The cells with the highest pacemaking activity
take the lead.
The leading pacemaker is always found at the
venous pole.
Sinuatrial node (SAN) develops during the fifth
week
lies near the opening of the superior venacava.
 Main conduction pathway between the SAN
and the AVN runs through the crista terminalis.
AVN lies at the base of the interatrial septum.
 Environmental causes-
Rubella virus, mumps, lithium, alcohol, retinoic acid,
phenylketonuria, trimathadione, phenytoin, thalidomide,
coumadin, diabetes in pregnancy, SLE.
Genetic abnormalities-
Noonan, Holt-Oram, Marfan, Ehlers-danlos type IV etc
Chromosomal defects-
Trisomies, monosomy(turner), deletion syndromes,
microdeletion syndromes etc.
 Heart lies on the right
side of the thorax
instead of the left.
Heart loops to the left
instead of right.
 Common congenital heart anomaly
Prevalence in female to male infants- 2:1

Four clinically significant types are:

Ostium secundum defect- most significant
Endocardial cushion defect with ostium primum defect
Sinus venosus defect
Common atrium (cor triculare biventriculare)
 Most common type of
congenital heart defect.
Occur more frequently in
males than females.
Two types- membranous
VSD (most common) and
muscular type.
 Transposition of Great arteries
 Most common congenital heart malformation.

Four classic malformations:

Pulmonary stenosis
Ventricular septal defect
Overriding aorta( rightward displacement of the aorta)
Right ventricular hypertrophy
 Pulmonary valve stenosis
 Pulmonary Atresia