Development of cardiovascular system primitive circulation •Primordium of the heart and vessels – in the middle of the 3rd week •The heart begins to beat at 22-23 days •Sono registration – during the 4th week •Primitive blood circulation. •Heart development (dev. of heart tube, septa and valves) •Aortal arches and their derivatives. •Fetal blood circulation. •Cardiovascular system malformations. •DAY 15 – 16 in extraembryonic mesoderm of • - yolk sac (vasa omphalomesenterica /vitellina/), • - connecting stalk and placenta (vasa umbilicalia) • •DAY 17 – 18 in mesenchyme of embryo • • • • • • •Vessels development: •(from week 3) • •hemangiogenesis •- blood islands •(insulae sanguinae) • Differentiation of mesenchymal cells Þ angiogenic cells: • - angioblasts ð endothelium (at the periphery of blood islets) • - hemoblasts ð primitive erythrocytes (in the center of blood islets) • • • • •Blood islet • angioblasts • •hemoblasts • • •primitive endothelium •primitive erythrocytes •Groups of angiogenic cells in mesenchyma •ectoderm • •mesenchyme • •endoderm • •angiogenic cells form a "horseshoe-shaped" space between somatic and splanchnic layer of mesoderm = pericardial cavity. •Two endothelial tubes arrise in splanchnic mesoderm. The ventral portion with tubes forms the cardiogenic area ð two heart tubes, while the lateral portions form the dorsal aortae. Krevní oběh, srdce,cévy - 3 Krevní oběh, srdce,cévy - 4 Figure 5 • cardev002-2a •Cardiogenic region just cranial to the prechordal plate. cardev003-1all • • • Krevní oběh, srdce,cévy - 5 Krevní oběh, srdce,cévy - 5 • •ð Fusion of heart tubes ð mesocardium dorsale ð diferentiation of heart wall: • ● endocardium • ● heart jelly • ● epimyocardium • •Vitelline, umbilical and intraembryonic vessels fuse together and form the primitive blood circulation (¹ fetal blood circulation!) ch1-1-a-img4-big.jpg (30258 bytes) • Tube7 tube5 Pericardial cavity Cor tubulare simplex •Septum transversum •Yolk sac •Connecting •stalk •Desc.aorta •Asc.aorta •Saccus aorticus •Truncus arteriosus •Sinus venosus • right horn degenerate •v. cardinalis ant. sin. • •v. cardinalis com.sin. • •v. cardinalis post. sin. •a. mesenterica sin. •aorta dorsalis •a. iliaca com.sin. •a. umbilicalis sin. from a. iliaca int. • v. umbilicalis sin. •v. omphalomesenterica sin. •Vessels •+ •cor •tubulare •branchial arteries 1-6 •aa.omphalomesentericae •Right Leftt • Ventral wiew • Histogenesis of heart tube wall • COR TUBULARE SIMPLEX– temporarily suspended on mesocardium dorsale (4). Visceral mesoderm (splanchnopleura, 5) propagates and forms myoepicardial coat ð myocardium (b) + epicardium (a). Below endothelium (d) – layer of cardiac jelly ð subendocardiac connective tissue (c). S2_4_02a • • • • •a b c d tube5 •Heart tube(s) • •Pericardial cavity • •(arrows show fixed postioin of cranial • and caudal end of the heart tube) •conus arteriosus •truncus arteriosus • cardev015-1a cardev017 • cardev018-2a •Looping of the heart tube • - because growth of the heart tube is faster than growth • of the pericardial cavity and both ends of tube are hold • by pericardium. tube5 atria1 • • •Bulboventricular loop •Ventro- •caudally •to the right •Dorso- •cranially • •ventral view lateral view Cor sigmoideum •Truncus arteriosus •+ saccus aorticus •Bulbus cordis •Ventriculus •Atrium •Sinus venosus •vv. cardinales communes •vv. umbilicales •vv. vitellinae •Cor • tubulare • simplex • •Cor • sigmoideum • uniloculare • •Cor • quadricameratum •Heart tube • •Septum atrioventriculare • •A/ Endocardial cushions – from dorsal (3) and ventral (2) wall of atrioventrikular canal. Grow against each other and seperate right and left AV canal (4, 5). •B/ Lateral interventricular cushions – bicuspid + tricuspid AV valve. S2_4_07a S2_4_07 •Ventriculus •Septum interventriculare •Grows from apex cordis craniallly to AV septum S2_4_04a 6- membranózní část septa 7- IV septum •Atrium •Septum atriorum -septum primum s ostium primum (obliteration); ostium secundum -septum secundum with foramen ovale • S2_4_06 atria2 •S1 – septum primum, O1 – ostium secundum •Septum primum •Grows from dorsocranial wall – ostium primum (caudally), closes later, and • ostium secundum (above) appears by cell apoptosis • • • • atria3 •S1 – septum primum, SS – septum spurium, •O1 – ostium primum, EC – endocard. cushion, •Perf – perforation of ostium secundum, SAO – sinoatrial orifice, •In septum primum by cell apoptosis foramen secundum will arrise • Plné kosočtverce • • • • • • • •S1 – septum primum, S2 – septum secundum, SS – septum spurium, •O1 – foramen secundum, FO – foramen ovale, EC – endocard. cushion, •LVV – left venous valve atria4 •Septum secundum -semicircular fold, does not reache endocardial cushions; -covers foramen secundum in septum primum and by its free lower margin surrounds foramen ovale • • • • • atria5 •S1 – septum primum (valvula foraminis ovalis), S2 – septum secundum, SS – septum spurium, O1 – foramen secundum, FO – foramen ovale, EC – endokardový polštářek, Perf – perforace, SAO – sinoatriání orificium, LVV – levá venózní chlopeň • • • • • •Blood from v. cava under pressure flows from the right atrium into the left. • •before •and •after •birth • S2_4_06 •1. Vena cava superior 2. Venae pulmonales 3. Atrium sin. 4. Atrium dx. 5. Septum primum 6. Septum secundum 7. Primitive left atrium 8. Primitive right atrium 9. Valve of vena cava inferior 10. Valve of sinus coronarius 11. Sinus venosus •Sinus venosus •vv. cardinales communes •vv. umbilicales •vv. vitellinae •Left veins obliterate and - left part of sinus venosus ð sinus coronarius - right part of sinus venosus ð part of right atrium wall •Sinus venosus + atria •Truncus arteriosus •atrium •Sinus venosus: -transvesal part -R + L horns: • v. cardinalis comm. • v. umbilicalis • v. omphalomesenterica • • •On the right side: • •v. cava sup. •from v. cardin. comm. dx.+ v. precardin. dx. • • • • •v. cava inf. (posthepatic part) •from v. omphalomes. dx. • • •On the left side: • veins obliterate and give rise to •sinus coronarius • • • •(pictures - view from dorsal side) •Truncus arteriosus + aortic sac •separates into: -2 aortic roots with 6 pairs of aortic arches figdev2 •Bulbus cordis - cranial – truncus arteriosus - middle – conus arteriosus -caudal – part of ventricle wall • File:Gray466.png F1 •Bulbus cordis – participate in ventricle wall; •in RV - conus arteriosus, in LV – sinus aortae. Heart •Bulbus cordis a truncus arteriosus • a pair of opposing ridges appear in walls of bulbus cordis and truncus arteriosus. These ridges twist around each other, forming spiral aortico-pulmonary septum. •This septum divides bulbus cordis and truncus arteriosus into two channels, the aorta and the truncus pulmonalis. It also participates in the closure of the interventricular foramen • S2_4_05 •1. Aorta 2. a. pulmonalis sin. 3. Truncus pulmonalis 4. Septum interventriculare (muscular part) 5. right ventricle 6. membranous part of septum interventriculare •Septum aortopulmonale cardev033-2 figurelarge11-34 heart\cardev042.gif 368x320 Embryo Heart - Before Birth heart\cardev042a.gif 323x279 Embryo Heart - After Birth • • • • • • • Congenital malformations in CVS (the most frequent) •With left – right shunt (without cyanosis) atrial septum defect ventricular septum defect ductus arteriosus apertus (= patens, = persistens) •With right – left shunt (with cyanosis) Fallot tetralogy transposition of great vessels truncus arteriosus (common aorticopulmonal canal) tricuspid valve atresia •Without shunt coarctation of aorta aortic stenosis pulmonary stenosis dextrocardia (+situs inversus) ectopia cordis •Atrial Septal Defects •a group of common congenital anomalies defects occuring in a number of different forms and more often in females. heartASD •patent foramen ovale • •left-right shunting •Ventricular Septal Defect •The Ventricular Septal Defect occurs in the interventricular septum, and is more frequent in males that females. heartVSD •left-right shunting •Patent Ductus Arteriosus •occurs commonly in preterm infants, can close spontaneously (by day three in 60% of normal term neonates) the remainder are ligated simply and with little risk. heartPDA •left-right shunting •Tetralogy of Fallot •Named after Etienne-Louis Arthur Fallot (1888) who described it as "la maladie blue" and is a common developmental cardiac defect. The syndrome consists of a number of cardiac defects possibly stemming from abnormal neural crest migration. fallot consists of: 1.ventricular septal defect 2.pulmonary stenosis (valvular or infundibular) 3.results in an overriding aorta 4.right ventricular hypertrophy •Transposition of Great Vessels •Characterized by aorta arising from right ventricle and pulmonary artery from the left ventricle and often associated with other cardiac abnormalities (e.g. ventricular septal defect). transposition •right-left shunting •Tricuspid Atresia •Blood is shunted through an atrial septal defect to the left atrium and through the ventricular septal defect to the pulmonary artery. The shaded arrows indicate mixing of the blood. Tricuspid_atresia •right-left shunting •Coarctation of Aorta (preductal or postductal) • before or behind ductus arteriosus coarctation • Aortic Stenosis Pulmonary Stenosis aortic_stenosis_valvular pulmonary_stenosis_valvular •Hypoplastic Left Heart •Characterized by hypoplasia (underdevelopment or absence) of the left ventricle obstructive valvular and vascular lesion of the left side of the heart. hypoplastic_left%20_heart Functional_hypoplastic_left_heart •hypoplastic left hear functional hypoplastic left heart •Double Outlet Right Ventricle •De-oxygenated blood enters the aorta from the right ventricle and is returned to the body. double_outlet_right_ventricle •Pulmonary Atresia •Abnormal blood flow (as indicated by the shaded blue arrow) is from the right atrium and right ventricle through an atrial septal defect to the left side of the heart. Blood can reach the pulmonary arteries only through a patent ductus arteriosus. pulmonary_atresia •Thank you for your attention