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Questions and Answers
What are the two main types of atrial septal defects (ASDs)?
What are the two main types of atrial septal defects (ASDs)?
Persistent ostium primum and persistent ostium secundum.
How is a patent foramen ovale clinically significant?
How is a patent foramen ovale clinically significant?
It allows blood to pass to the left side under increased pressure conditions.
What is the primary defect in Roger disease?
What is the primary defect in Roger disease?
A persistent inter-ventricular foramen.
What portion of the interventricular septum develops from the floor of the primitive ventricle?
What portion of the interventricular septum develops from the floor of the primitive ventricle?
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What unfortunate outcome can occur due to premature closure of the foramen ovale?
What unfortunate outcome can occur due to premature closure of the foramen ovale?
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What forms the right limb of the developing heart tube?
What forms the right limb of the developing heart tube?
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What structures do the bulbar cushions contribute to during development?
What structures do the bulbar cushions contribute to during development?
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What condition is characterized by the heart lying as a mirror image of its normal position?
What condition is characterized by the heart lying as a mirror image of its normal position?
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What is a characteristic of a trilocuar biventricular heart anomaly?
What is a characteristic of a trilocuar biventricular heart anomaly?
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In which part of the heart development do the infundibulum of the right ventricle and vestibule of the left ventricle arise from?
In which part of the heart development do the infundibulum of the right ventricle and vestibule of the left ventricle arise from?
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What are the two primary sources of blood entering the sinus venosus?
What are the two primary sources of blood entering the sinus venosus?
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What happens to the right horn of the sinus venosus during development?
What happens to the right horn of the sinus venosus during development?
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How is the atrio-ventricular canal divided during embryonic development?
How is the atrio-ventricular canal divided during embryonic development?
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What is the fate of the left horn of the sinus venosus?
What is the fate of the left horn of the sinus venosus?
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What defines ectopia cordis?
What defines ectopia cordis?
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What valves are formed from the right sino-atrial valve?
What valves are formed from the right sino-atrial valve?
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What is the role of the septum intermedium in the heart's embryological development?
What is the role of the septum intermedium in the heart's embryological development?
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How do tricuspid stenosis and mitral regurgitation affect the septum intermedium?
How do tricuspid stenosis and mitral regurgitation affect the septum intermedium?
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What happens to the ostium primum during the development of the inter-atrial septum?
What happens to the ostium primum during the development of the inter-atrial septum?
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Describe the fate of the foramen ovale after birth.
Describe the fate of the foramen ovale after birth.
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What separates the septum primum from the septum secundum?
What separates the septum primum from the septum secundum?
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What embryological origins contribute to the formation of the inter-atrial septum?
What embryological origins contribute to the formation of the inter-atrial septum?
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What causes the septum intermedium to deviate to the left side?
What causes the septum intermedium to deviate to the left side?
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What two structures close after birth to form the fossa ovalis?
What two structures close after birth to form the fossa ovalis?
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What is the pathway of oxygenated blood from the placenta to the fetus?
What is the pathway of oxygenated blood from the placenta to the fetus?
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What two major changes occur in the circulatory system immediately after birth?
What two major changes occur in the circulatory system immediately after birth?
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What anatomical structures are formed from the left umbilical vein and ductus venosus after birth?
What anatomical structures are formed from the left umbilical vein and ductus venosus after birth?
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Which structure allows blood to bypass the lungs in fetal circulation?
Which structure allows blood to bypass the lungs in fetal circulation?
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How is blood mixed in the right atrium during fetal circulation?
How is blood mixed in the right atrium during fetal circulation?
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When does the development of the cardiovascular system begin in relation to the central nervous system?
When does the development of the cardiovascular system begin in relation to the central nervous system?
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At what point is the fetal heartbeat first detected by ultrasound?
At what point is the fetal heartbeat first detected by ultrasound?
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What embryological origin is responsible for the formation of the heart tube?
What embryological origin is responsible for the formation of the heart tube?
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What is the commonest cyanotic heart disease and its primary features?
What is the commonest cyanotic heart disease and its primary features?
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Describe the fate of the aortic sac during development.
Describe the fate of the aortic sac during development.
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What structures do the 3rd aortic arch develop into?
What structures do the 3rd aortic arch develop into?
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What happens to the 5th aortic arch during development?
What happens to the 5th aortic arch during development?
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What are the two main parts that form the right ventricle?
What are the two main parts that form the right ventricle?
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Which structures result from the 4th aortic arch on the right and left sides?
Which structures result from the 4th aortic arch on the right and left sides?
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Describe the developmental origin of the left ventricle.
Describe the developmental origin of the left ventricle.
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What does the 6th aortic arch develop into on both sides?
What does the 6th aortic arch develop into on both sides?
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Explain the significance of the recurrent laryngeal nerve in relation to the 6th aortic arch.
Explain the significance of the recurrent laryngeal nerve in relation to the 6th aortic arch.
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What is the role of the endocardial cushions in the development of the semilunar valves?
What is the role of the endocardial cushions in the development of the semilunar valves?
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What are the primary characteristics of Fallot's Pentalogy?
What are the primary characteristics of Fallot's Pentalogy?
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Explain the significance of the spiral course of the aortico-pulmonary septum.
Explain the significance of the spiral course of the aortico-pulmonary septum.
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What is persistent truncus arteriosus and what causes it?
What is persistent truncus arteriosus and what causes it?
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Describe how transposition of the great vessels occurs.
Describe how transposition of the great vessels occurs.
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What structures develop in the bulbus cordis to contribute to the formation of the semilunar valves?
What structures develop in the bulbus cordis to contribute to the formation of the semilunar valves?
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What anomalies are associated with the development of the semilunar valves?
What anomalies are associated with the development of the semilunar valves?
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What is the primary consequence of the failure of septum primum and secundum to fuse during fetal development?
What is the primary consequence of the failure of septum primum and secundum to fuse during fetal development?
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What part of the interventricular septum is most commonly affected in Roger disease?
What part of the interventricular septum is most commonly affected in Roger disease?
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Describe the fate of the proximal part of the bulbus cordis during heart development.
Describe the fate of the proximal part of the bulbus cordis during heart development.
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What is the main embryological cause of a trilocuar biventricular heart anomaly?
What is the main embryological cause of a trilocuar biventricular heart anomaly?
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What are the implications of persistent inter-ventricular foramen on cardiac function?
What are the implications of persistent inter-ventricular foramen on cardiac function?
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How does the development of the muscular and membranous parts of the interventricular septum differ?
How does the development of the muscular and membranous parts of the interventricular septum differ?
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What leads to premature closure of the foramen ovale during intra-uterine life?
What leads to premature closure of the foramen ovale during intra-uterine life?
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In the context of anomalies, what is significant about a probe patent foramen ovale?
In the context of anomalies, what is significant about a probe patent foramen ovale?
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What role do the anterior and posterior cushions play in the division of the atrio-ventricular canal?
What role do the anterior and posterior cushions play in the division of the atrio-ventricular canal?
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Describe how the growth of the right horn of the sinus venosus affects its structure.
Describe how the growth of the right horn of the sinus venosus affects its structure.
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Explain the relationship between ectopia cordis and the heart's exposure through the chest wall.
Explain the relationship between ectopia cordis and the heart's exposure through the chest wall.
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What structures form the fate of the left horn and body of the sinus venosus?
What structures form the fate of the left horn and body of the sinus venosus?
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What is the significance of the sino-atrial valve regarding blood flow within the heart?
What is the significance of the sino-atrial valve regarding blood flow within the heart?
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What happens to the upper part of the atrio-ventricular canal during development?
What happens to the upper part of the atrio-ventricular canal during development?
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In what way does the right sino-atrial valve contribute to cardiac anatomy?
In what way does the right sino-atrial valve contribute to cardiac anatomy?
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How does the lateral displacement of blood to the right side during liver development affect the right horn of the sinus venosus?
How does the lateral displacement of blood to the right side during liver development affect the right horn of the sinus venosus?
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What causes the functional closure of the foramen ovale immediately after birth?
What causes the functional closure of the foramen ovale immediately after birth?
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What anatomical change occurs to the ductus arteriosus after birth?
What anatomical change occurs to the ductus arteriosus after birth?
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Describe the pathway of blood flow through the fetal circulation.
Describe the pathway of blood flow through the fetal circulation.
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What are the fates of the umbilical arteries after birth?
What are the fates of the umbilical arteries after birth?
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What changes in pressure cause the ductus venosus to close after birth?
What changes in pressure cause the ductus venosus to close after birth?
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How does the right atrium receive mixed blood during fetal circulation?
How does the right atrium receive mixed blood during fetal circulation?
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What embryological structures contribute to the formation of the heart tube?
What embryological structures contribute to the formation of the heart tube?
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What is the significance of the changes that occur in the cardiovascular system immediately after birth?
What is the significance of the changes that occur in the cardiovascular system immediately after birth?
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What anatomical structures contribute to the formation of the inter-atrial septum?
What anatomical structures contribute to the formation of the inter-atrial septum?
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How does tricuspid regurgitation and mitral stenosis affect the positioning of the septum intermedium?
How does tricuspid regurgitation and mitral stenosis affect the positioning of the septum intermedium?
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What happens to the septum primum and septum secundum after birth regarding the foramen ovale?
What happens to the septum primum and septum secundum after birth regarding the foramen ovale?
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What is the fate of the lower edge of the septum secundum after birth?
What is the fate of the lower edge of the septum secundum after birth?
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What are the consequences of tricuspid stenosis combined with mitral regurgitation on the heart's septal structure?
What are the consequences of tricuspid stenosis combined with mitral regurgitation on the heart's septal structure?
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Describe the contribution of the AV canal in the formation of the inter-atrial septum.
Describe the contribution of the AV canal in the formation of the inter-atrial septum.
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What is the significance of the foramen ovale in fetal circulation?
What is the significance of the foramen ovale in fetal circulation?
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What is the relationship between the ostium primum and septum primum during inter-atrial septum development?
What is the relationship between the ostium primum and septum primum during inter-atrial septum development?
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What determines the division of the truncus arteriosus into the pulmonary trunk and ascending aorta?
What determines the division of the truncus arteriosus into the pulmonary trunk and ascending aorta?
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What characterizes persistent truncus arteriosus in embryological development?
What characterizes persistent truncus arteriosus in embryological development?
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How does the configuration of the aortico-pulmonary septum influence the position of the pulmonary trunk relative to the ascending aorta?
How does the configuration of the aortico-pulmonary septum influence the position of the pulmonary trunk relative to the ascending aorta?
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What are the four primary defects associated with Fallot's Tetralogy?
What are the four primary defects associated with Fallot's Tetralogy?
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What is the significance of the hollowing out of the upper surface of the semilunar valve cusps during development?
What is the significance of the hollowing out of the upper surface of the semilunar valve cusps during development?
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What role does the left horn of the aortic sac play in embryological heart development?
What role does the left horn of the aortic sac play in embryological heart development?
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What are the potential anomalies resulting from improper development of the semilunar valves?
What are the potential anomalies resulting from improper development of the semilunar valves?
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In the context of cardiac development, what is the role of the endocardial cushions?
In the context of cardiac development, what is the role of the endocardial cushions?
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Explain the outcome of the right 6th aortic arch during development.
Explain the outcome of the right 6th aortic arch during development.
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What occurs to the 5th aortic arch during embryological development?
What occurs to the 5th aortic arch during embryological development?
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What is transposition of the great vessels, and what causes this condition in embryonic development?
What is transposition of the great vessels, and what causes this condition in embryonic development?
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What parts of the heart are formed by the rough inflowing and smooth outflowing portions of the right and left ventricles?
What parts of the heart are formed by the rough inflowing and smooth outflowing portions of the right and left ventricles?
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Describe the primary characteristic of Fallot's pentalogy.
Describe the primary characteristic of Fallot's pentalogy.
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What is the significance of the recurrent laryngeal nerve in embryonic heart development?
What is the significance of the recurrent laryngeal nerve in embryonic heart development?
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What vessels arise from the 4th aortic arch on both sides?
What vessels arise from the 4th aortic arch on both sides?
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What was the initial fate of the aortic sac during the development of the cardiovascular system?
What was the initial fate of the aortic sac during the development of the cardiovascular system?
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Study Notes
Embryology of the CVS
- The cardiovascular system (CVS) is the second system to develop after the central nervous system (CNS).
- The first heartbeat is detected at 22 days (4th week) in utero.
- Fetal circulation involves oxygenated blood from the placenta traveling via the umbilical vein to the liver, then through the ductus venosus to the inferior vena cava (IVC).
- Additional blood enters the right atrium from the superior vena cava (SVC).
- Most of the blood from the right atrium flows to the left atrium through the foramen ovale.
- A smaller amount flows into the right ventricle and then into the pulmonary trunk (directed towards the lungs).
- Blood from the right ventricle then bypasses the lungs through the ductus arteriosus to the descending aorta.
- The less oxygenated blood is transported through the umbilical arteries.
- Blood mixing occurs in the liver sinusoids, IVC, right atrium, and left atrium.
- The heart tube develops from the cardiogenic mesoderm and fuses to form a single tube.
- The tube is divided into five segments: sinus venosus, primitive atrium, primitive ventricle, bulbus cordis, and truncus arteriosus.
- The heart tube bends into an S-shape as it develops, forming the right and left limbs.
- The right limb involves the truncus arteriosus and bulbus cordis.
- The transverse limb arises from the primitive ventricle.
- The left limb involves the primitive atrium and sinus venosus.
- The sinus venosus develops into the posterior smooth part of the right atrium.
- The left horn and body of the sinus venosus become the coronary sinus.
- The atrioventricular (AV) canal is divided into right and left halves by anterior and posterior cushions.
- The upper part of the AV canal is absorbed into the atria.
- The lower part of the AV canal is absorbed into the ventricles.
- The central part of the AV canal contributes to the formation of tricuspid and mitral valves.
- The interatrial septum is formed of mesodermal cushions.
- A C-shaped septum primum grows towards the septum intermedium with an ostium primum.
- The ostium primum closes, and an ostium secundum appears later.
- A septum secundum forms a passage called the foramen ovale.
- The right atrium is formed from the right half of the primitive atrium and absorbed portions of the right AV canal and sinus venosus.
- The left atrium develops from the left half of the primitive atrium and absorbed sections of the left AV canal and pulmonary veins.
- The interventricular septum is formed by muscular and membranous parts.
- The bulbus cordis differentiates into right and left ventricles, as well as the infundibulum of the right and the vestibule of the left ventricle.
- The development of the semilunar valve involves endocardial cushions within the bulbus cordis.
- The development of aortic arches begins with the aortic sac which forms parts of the great vessels and eventually the arch of the aorta.
- Aortic arches also form various arteries.
- The fetal ductus arteriosus and foramen ovale close after birth. The ductus arteriosus contributes to the development of the ligamentum arteriosum.
Anomalies
- Dextrocardia: The heart is in the mirror image position.
- Ectopia cordis: The heart is exposed outside the thorax.
- ASD (atrial septal defect): Persistent ostium primum or secundum, persistent ostium secundum.
- VSD (ventricular septal defect): The interventricular septum fails to close, persistent interventricular foramen.
- PTA (persistent truncus arteriosus): Failure of the aorticopulmonary septum formation.
- TGA (transposition of the great vessels): Abnormalities in the connection of the aorta and the pulmonary trunk from the ventricles, straight course of aorticopulmonary septum, aorta connected to right ventricle and pulmonary trunk connecting to left ventricle.
- Fallot's tetralogy: Includes pulmonary stenosis, right ventricular hypertrophy, a ventricular septal defect (VSD), overriding aorta and a variable right ventricular outflow obstruction.
- Persistent ductus arteriosus: The duct connecting the aorta and the pulmonary artery persists.
- Aortic coarctation: Narrowing of the aorta. There are pre-ductal and post-ductal types. Pre-ductal coarctation is proximal to the ductus arteriosus; post-ductal is distal.
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