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Updated: Oct 12 2022

Cardiac Development

  • Overview
    • Heart development
      • 5 dilatations along primitive heart tube forms into adult heart structures
      • dextral looping of the primitive heart aligns the heart chambers and structures
      • septum and valves develop which allow for separation of the venous and arterial circulatory pathways
      • heart begins beating during week 4
        • can be detected by transvaginal ultrasound by week 6
  • Embryonic structures
      • Embryonic structure
      • Adult structure
      • Truncus Arteriosus
      • Ascending aorta
      • Pulmonary trunk
      • Bulbus cordis
      • Smooth part of left and right ventricle
      • Primitive ventricle
      • Trabeculated part of left and right ventricle
      • Primitive atria
      • Trabeculated part of left and right atrium
      • Sinus venosus
      • Coronary sinus
      • Smooth part of right atrium
      • Right common and right anterior cardinal vein
      • SVC
    • Truncus arteriosus
      • neural crest cells migrate from hindbrain to aorticopulmonary (AP) trunk
        • cells invade truncal and bulbar ridges
        • the ridges then twist, spiral, and fuse to form the AP septum dividing the AP trunk into the ascending aorta and pulmonary trunk
    • Persistent truncus arteriosus
      • partial development of AP septum resulting in mixing of oxygenated and deoxygenated blood leading to cyanosis
    • Transposition of great vessels (transposition of great arteries)
      • ridges do not spiral as they develop resulting in two separate circulatory pathways
        • aorta arises from the right ventricle
        • pulmonary artery arises from the left ventricle
      • blood never gets oxygenated which will result in neonatal death, unless there is a shunt between the two pathways
        • VSD, patent foramen ovale, or PDA
    • Tetralogy of Fallot
      • skewed development of AP septum resulting in
        • Pulmonary stenosis
        • Right ventricular hypertrophy
        • Overriding aorta
        • VEntricular septal defect
      • cyanosis but severity depends on degree of pulmonary stenosis
  • Interventricular septum development
    • Muscular ventricular septum
      • forms from the floor of the primitive ventricle
      • opening between muscular ventricular septum and fused AV cushions is called interventricular foramen
      • AP septum then fuses with muscular ventricular septum to form the membranous interventricular septum
    • Common ventricle
      • muscular and membranous interventricular septum do not form
    • Membranous septal defect
      • failure of the membranous interventricular septum to form properly
      • blood flows from left to right due to higher pressure in systemic circulatory system
      • as a result pulmonary hypertension develops
        • the lumen of pulmonary arteries and arterioles narrow due to proliferation of the tunica media and intima
      • pulmonary resistance then becomes greater than systemic reversing the flow of blood across the opening
      • the resulting condition is called Eisenmenger complex
  • Interatrial septum development
    • Septum primum
      • grows downward from the superior part of the primitive atrium
      • as the septum primum nears the atrioventricular cushions, new openings form at the center creating the foramen secundum
      • foramen secundum allows for shunting of the blood from right to left
    • Septum secundum
      • grows downward and covers the foramen secundum leaving an opening inferiorly
      • superior portion of septum primum degenerates
      • inferior portion of septum primum and septum secundum form the foramen ovale
      • foramen ovale remains open until birth
      • at birth, right atrial pressure decreases and left aftrial pressures increases due to increased pulmonary blood flow into left atrium resting in the closure of the foramen ovale
    • Patent foramen ovale
      • foramen ovale does not close due to excessive resorption of septum primum, secundum, or both
    • Interatrial septum needs to be penetrated to allow for access to the left side of the heart during procedures
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