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Embryology of the

cardiovascular system
Early development of the heart

Development of veins associated with the heart

Later development of the heart

Circulation through the primordial heart

Partitioning of the primordial atrium

Partitioning of the primordial ventricle

Anomalies of the heart

The cardiovascular system is the first major system
to function in the embryo.
The primordial heart and vascular system appear in
the middle of the third week.
This precocious cardiac development is necessary
because the rapidly growing embryo can no longer
satisfy its nutritional and oxygen requirements by
diffusion alone.

Primordium of the hearts are derived from Splanchnic mesoderm.

The earliest sign of the heart is the appearance of paired

endothelial strands-angioblastic cords-in the cardiogenic mesoderm
during the third week.
An inductive influence from the anterior endoderm stimulates early
formation of the heart.

The heart begins to beat at 22 to 23 days.

Blood flow begins during the fourth week(27-29day).

At first the heart forms straight tube inside the
pericardial cavity. The intrapericardial part consists of
the future bulboventricular portion. The atrial
portion and the sinus venosus are still paired and lie
outside the pericardium in the mesenchyme of the
septum transversum.
The heart tube continues to elongate and begins to
bend, which creates the cardiac loop.
a. Cephalo-caudal folding: the cephalic portion bends in
ventral and caudal directions and to the right, while
the caudal atrial portion shifts in a dorsocranial
direction and to the left.
b. Lateral folding: the two heart-tubes fuse, the ventral
and lateral sides surrounded by pericardium, and
attached to foregut by dorsal mesocardium, which
disappears with further development.
Formation of cardiac bulges
While the cardiac loop is being formed, local
expansions become visible throughout the length of
the tube.
The atrial portion initially paired, located outside the
pericardial cavity forms a common atrium and
becomes incorporated into the pericardial cavity. The
atrioventricular junction remains narrow and forms the
atrioventricular canal, which connects the common
atrium and the early embryonic ventricle.
Four pairs of bulges from cephalic to caudal
a. Bulbus cordis
b. Ventricle
c. Atrium
d. Sinus venosus
Atrium moves up and behind the bulbus cordis
Sinus venosus follows along and then moves
The coiling of the primitive heart tube into its definitive form

Three paired veins drain into the tubular heart of a 4-week


1. Vitelline veins which return deoxygenated blood from yolk suck

2. Umbilical veins which return from oxygenated blood from placenta

3. Common cardinal which return deoxygenated blood from embryo

Sinus venosus
Consists of body and 2 horns
Each horn receives 3 veins
a. vitelline vein (yolk sac)
b. umbilical vein (placenta)
c. common cardinal vein (embryo)
i. On the left side
a. vitelline vein disappears
b. umbilical vein disappears
c. common cardinal vein develops into the left coronary
d. left horn develops into coronary sinus
ii. On the right side
a. vitelline vein develops into inferior vena cava
b. umbilical vein disappears
c. common cardinal vein develops into superior vena
d. right horn is absorbed by right atrium and develops
into sinus venarum cavarum.
As the heart tubes fuse,the primordial myocardium-is
formed from splanchnic mesoderm

The heart tube consists of three layers:

Endocardium-forming the internal endothelial lining of

the heart

Myocardium- forming the muscular wall

Epicardium-covering the outside of the tube.

Partitioning of the atrioventricular canal

primordial atrium, and ventricle begins around the middle of

the fourth week and is essentially completed by the end of the
eighth week.

Partitioning of the Atrioventricular Canal toward the end of

the fourth week, endocardial cushions form on the dorsal and

ventral walls of the atrioventricular (AV) canal.

The AV endocardial cushions approach each other and fuse

dividing the AV canal into right and left AV canals.

Beginning at the 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: the
septum primum and septum secundum.

The septum primum : thin membrane, grows toward the

fusing endocardial cushions from the roof of the primordial
atrium, partially dividing the common atrium into right and
left halves.
The foramen primum serves as a shunt, enabling
oxygenated blood to pass from the right to the left atrium.

The foramen primum becomes progressively smaller and

disappears as the septum primum fuses with the fused
endocardial cushions to form a primordial AV septum

As the septum fuses with the fused endocardial cushions,

another opening in the septum primum, the foramen
secundum formed.
The foramen secundum ensures continued shunting of
oxygenated blood from the right to the left atrium

The septum secundum: a thick muscular fold, grows

from the ventrocranial wall of the right atrium,
immediately adjacent to the septum primum .

The septum secundum forms an incomplete partition

between the atria; consequently, an oval foramen forms.
The development of the chambers of the heart

Most of the wall of the left atrium is smooth because it is

formed by incorporation of the primordial pulmonary vein .

As the atrium expands, the primordial pulmonary vein and

its main branches are incorporated into the wall of the left

-proximal part of bulbus cordis is absorbed by the
common ventricular chamber.
-muscular interventricular septum develop from the floor
of the chamber and ascends towards the AV septum.
-membranous interventricular septum develops from the
AV septum and fuses with the muscular part of the
interventricular septum.
-Bulbar septum develops from the wall of the proximal
part of bulbus cordis and descends in a spiral fashion to
fuse with the membranous part of the interventricular
-this bulbar septum divides the bulbus cordis into
ascending aorta and pulmonary trunk.
Derivatives of Pharyngeal Arches
i. 1st Aortic arch: disappears, small portion persists to form
the maxillary artery.
ii. 2nd Aortic arch: disappears, the remaining of this arch are
hyoid and stapedial arteries.
iii. 3rd Aortic arch: forms the common carotid artery and the
proximal part of internal carotid artery. The remainder of
the internal carotid artery is formed by the cranial
portion of the dorsal aorta. The external carotid artery is
a sprout of the third aortic arch.
iv. 4th Aortic arch: persists on both sides
a. Right side: forms the proximal part of the right
subclavian artery, the distal part of which is formed by a
portion of the right dorsal aorta and the 7th
intersegmental artery.
b. Left side: forms the 3rd part of the aortic arch.
v. 5th Aortic arch: is transient and is never well
vi. 6th Aortic arch: also known as pulmonary arch
a. Proximal part: becomes the proximal segment of
the right pulmonary artery.
b. Distal part: -the right side loses its connection with
the dorsal aorta and disappears.
- the left side persists during intrauterine life as the
ductus arteriosus (connects left pulmonary artery
with arch of the aorta).
Obliterated Ascending
aortic arch I aorta Septum b/n
III aorta and
Maxillary II pulmonary
artery III IV artery
IV Pulmonary
IV VI trunk
pulmonary art. Primitive
Right pulmonary art.
dorsal Left dorsal
aorta aorta
Left 7th
A - 4mm Stage intersegmental
B - 10mm Stage artery

A: Aortic arches at the 4 mm stage. The 1st aortic arch is obliterated before the 6th
arch has fully developed.
B: Aortic arch system at the 10 mm stage. Note the aorticopulmonary septum
and the large primitive pulmonary arteries.
Derivatives of Aortic Sac
-absorbs distal part of bulbus cordis
i. Proximal part
a. ventral part: forms the 1st part of Aortic Arch
b. dorsal part: forms the 1st part of Pulmonary Trunk
ii. Distal part has 2 horns
a. left horn: forms the 2nd part of Aortic Arch
b. right horn: forms Brachiocephalic Trunk
Derivatives of 2 Dorsal Aortae
i. right side: forms parts of Subclavian Artery
ii. left side: forms the 4th part of Aortic Arch and
Descending aorta
Both sides also form parts of Internal carotid artery
External Carotid
Dorsal aorta Internal carotid arteries
Aortic artery
arches Right vagus
nerve Left vagus nerve
2 Common
3 carotid artery
Arch of aorta
4 Right
5 Subclavian artery Left recurrent nerve
6 Right recurrent
nerve Ductus arteriosus
7 Intersegmental
Right dorsal
aorta Pulmonary artery

Right external A: Aortic arches and

carotid artery Left internal carotid artery
dorsal aortas before
Right vagus Left common carotid artery transformation into
definitive vascular
Right subclavian Left subclavian artery
artery pattern
Brachiocephalic Ligamentum arteriosum B: Aortic arches and
artery dorsal aorta after
Ascending aorta
Pulmonary artery Descending aorta C: The great arteries in
the adult
Vitelline and Umbilical arteries
i. The vitelline arteries, initially a number of paired
vessels supplying the yolk sac, gradually fuse and
form arteries located in the dorsal mesentery of the
gut. In adult they are represented by the celiac,
superior mesenteric and inferior mesenteric arteries.
ii. The umbilical arteries, After birth, the proximal
portions of the umbilical arteries persist as the
internal iliac and the superior vesical arteries, while
the distal parts are obliterated to form the medial
umbilical ligaments.
Development of the venous system
In the 5th week, three pairs of major veins can be
i. vitelline veins
ii. umbilical veins
iii. cardinal veins
i. Vitelline veins: are divided into 3 parts by the liver.
a. superior part
-right side: suprahepatic part of inferior vena cava
-left side: disappears
b. middle part
-liver sinusoids
c. inferior part
-left and right parts anastomose with each other to form
portal vein
ii. Umbilical veins: divided in 3 parts by the liver
a. superior part: - disappears
b. middle part: - liver sinusoids
c. inferior part
- right side: disappears
-left side: persists as left umbilical vein
-joins suprahepatic part of inferior vena cava by
ductus venosus
The proximal part of both umbilical veins as well as
the remainder of the right umbilical vein disappear,
so that the left vein is the only to carry blood from
the placenta to the liver.
With the increase of the placental circulation, a
direct communication is formed between the left
umbilical vein and the right hepatocardiac channel,
the ductus venosus. This vessel by pass the
sinusoidal plexus of the liver.
After birth, the left umbilical vein and ductus
venosus are obliterated and form the ligamentum
teres hepatis and ligamentum venosum respectively.
Development of the vitelline and umbilical veins during the 4th A and 5th B
Note the plexus around the duodenum, the formation of the hepatic
sinusoids and the beginning of the left-to-right shunt between the vitelline
Hepatic portion of
Hepatic vein inf. vena cava
Right (right vitelline) Hepatic vein
Ductus venosus

Portal vein
Duodenum Left
B umbilical
A Left umbilical vein
Sup. mesenteric vein
Vitelline veins Splenic vein

Development of vitelline and umbilical veins in the 2nd A and 3rd B months.
Note: the formation of the ductus venosus, the portal vein and the hepatic portion
of the inferior vena cava. The splenic and superior mesenteric veins enter into the
portal vein.
iii. Cardinal veins
a. Anterior cardinal veins
-the right vein becomes superior vena cava
b. Posterior cardinal veins
- obliterated and replaced by Supracardinal and
Subcardinal veins.
The cardinal veins form the main venous drainage system
of the embryo. This system consists of the anterior
cardinal veins, which drain the cephalic part of the
embryo, and the posterior cardinal veins, which drain
the remaining part of the body of the embryo.
The anterior and the posterior veins join before
entering the sinus horn and form the short common
cardinal veins. During the 4th week, the cardinal veins
form a symmetrical system.
During the 5th to the 7th week, a number of additional
veins are formed:
-the subcardinal veins, which mainly drain the kidneys
-the sacrocardinal veins, which drain the lower
-the supracardinal veins, which drain the body wall by
way of the intercostal veins, thereby taking over the
function from the posterior cardinal veins.
Formation of the vena cava system: -is characterized by the
appearance of anastomoses between left and right in such a
way that the blood from the left is channeled to the right
-Anastomosis between the anterior cardinal veins develops into
the left brachiocephalic vein. Most of the blood from the left
side of the head and the left upper extremity is then
channeled to the right.
-The terminal portion of the left posterior cardinal vein entering
into the left brachiocephalic vein is retained as a small vessel,
the left superior intercostal vein. It receives blood from the
2nd and 3rd intercostal spaces.
The superior vena cava is formed by the right common cardinal
vein and the proximal portion of the right anterior cardinal
Development of inferior vena cava
i. Suprahepatic: -right vitelline vein
ii. Hepatic: -anastomosis between right vitelline vein
and right subcardinal vein
iii. Prerenal: -right subcardinal vein
iv. Renal: -anastomosis between right subcardinal vein
and right supracardinal vein
v. Post renal: -right supracardinal vein
vi. Caudal: -anastomosis between 2 remnants of
posterior cardinal veins.
Fetal circulation, circulatory changes at birth
Supply of upper body
Oxygenated blood from the placenta
Left umbilical vein
Ductus venosus (majority) / portal circulation
Inferior vena cava
Right atrium
Foramen ovale
Left atrium
Left AV ostium
Left ventricle
Ascending aorta to supply the upper body
Supply of lower body
Venous blood from upper body
Superior vena cava
Right atrium
Right AV ostium
Right ventricle
Pulmonary trunk
Ductus arteriosus
Descending aorta
Umbilical arteries
Placenta to be reoxygenated
Ductus arteriosus Pulmonary vein
Sup. vena cava
Pulmonary vein

Crista dividens
Oval foramen III
Pulmonary artery
Inf. vena cava
Descending aorta
Ductus venosus I
Sphincter in ductus venosus Portal
Inf. Vena cava Umbilical

Umbilical arteries

Fetal circulation
Before birth, blood from placenta, -about 80% saturated
with oxygen- returns to the fetus by way of the umbilical
On approaching the liver, the main portion of this blood
flows through the ductus venosus directly into the
inferior vena cava. A smaller portion enters the liver
sinusoids and mixes with blood from the portal
A sphincter mechanism in the ductus venosus, close to
the entrance of the umbilical vein, regulates the flow of
umbilical blood through the liver sinusoids.
It is thought that this sphincter closes when, the venous
return is too high during uterine contraction, thereby
prevents a sudden overload of the heart.
In the inferior vena cava the placental blood mixed
with deoxygenated blood returning from the lower
limbs, and enters the right atrium.
Guided toward the oval foramen by the valve of the
inferior vena cava, the major portion of the blood
stream passes directly into the left atrium.
A small portion is prevented from so doing by the
lower edge of the septum secundum, the crista
dividens and remain in the right atrium. Here it mixes
with the desaturated blood returning from the head
and arms by way of the superior vena cava.
From the left atrium, where it mixes with a small
amount of desaturated blood returning from the
lungs, the blood stream enters the left ventricle and
ascending aorta.
The desaturated blood from the superior vena cava
flows by way of the right ventricle into the
pulmonary trunk. The resistance in the pulmonary
vessel is high during fetal life, hence the main portion
of this blood passes directly through the ductus
arteriosus into the descending aorta. Then the blood
stream flows toward the placenta by way of the two
umbilical arteries. The oxygen saturation in the
umbilical arteries is about 58%.
The blood in the umbilical vein has its high oxygen
content gradually decreased by mixing with desaturated
-in the liver by mixture with a small amount of blood
returning from the portal system
-in inferior vena cava which carries deoxygenated blood
returning from the lower extremities, pelvis and kidneys
-in the right atrium by mixture with blood returning from
the head and limbs
-in the left atrium by mixture with blood returning from the
-at the entrance of the ductus arteriosus into the
descending aorta
Changes at birth
i. Closure of the umbilical arteries: accomplished by
contraction of smooth muscle in their walls due to
thermal and mechanical stimuli and a change in
oxygen tension. Functionally they are closed a few
minutes after birth, the actual obliteration by fibrous
proliferation takes 2 to 3 months. The distal parts of
the umbilical arteries from the medial umbilical
ligaments and the proximal portion remain open as
the superior vesical arteries and internal illiac artery.
ii. Closure of the umbilical vein and ductus venosus:
occurs shortly after that of the umbilical arteries. For
some time after birth blood from the placenta may
enter the newborn.
After obliteration, the umbilical vein forms the
ligamentum teres hepatis in the lower margin of the
falciform ligament.
The ductus venosus also obliterated and forms the
ligamentum venosum.
iii. Closure of the ductus arteriosus: occurs immediately
after birth, due to contraction of its wall mediated by
bradykinin, a substance released from the lungs
during initial inflation. Complete anatomical
obliteration takes from1 to 3 months. The obliterated
ductus arteriosus forms the ligamentum arteriosum.
iv. Closure of the oval foramen: occurs due to an
increased pressure in the left atrium combined with
a decrease in pressure on the right side. With the
first good breath the septum primum is pressed
against the septum secundum.
Are common, with a frequency of six to eight cases per 1000 births
chromosomal abnormality.
Teratogens such as the rubella virus .
multifactorial inheritance(genetic and environmental )
Most CHDs are well tolerated during fetal life; however, at birth,
when the fetus loses contact with the maternal circulation, the
impact of CHDs becomes apparent.

If the heart tube bends to the left instead of to the right,

the heart is displaced to the right and there is
transposition-the heart and its vessels are reversed left to
right as in a mirror image.

The most frequent positional abnormality of the heart.

If there is no other associated vascular abnormalities,

these hearts function normally.

An abnormal location of the heart

An extremely rare condition.

The heart is partly or completely exposed on the surface of

the thorax.

Death occurs in most cases during the first few days after
birth, usually from infection and cardiac failure.

Common congenital heart anomaly & occurs more frequently in

females than in males.

The most common form of ASD is patent oval foramen

There are four clinically significant types of ASD :
I. Ostium secundum defect

II. Endocardial cushion defect with ostium primum defect

III. Sinus venosus defect

IV. Common atrium.

The first two types of ASD are relatively common.


Are the most common type of CHD(25% of defects).

Occur more frequently in males than in females.

VSDs may occur in any part of the IV septum,but membranous VSD is

the most common type.

Most people with a large VSD have massive left-to-right shunting of


It is classic group of four cardiac defects consists of:

1.Pulmonary stenosis
2. VSD
3. Dextroposition of aorta (overriding or straddling aorta)
4. Right ventricular hypertrophy

The pulmonary trunk is usually small(pulmonary artery stenosis)

Cyanosis is an obvious sign of the tetralogy.

This anomaly results when division of the TA is so unequal that the

pulmonary trunk has no lumen, or there is no orifice at the level of the

pulmonary valve
The left ventricle is small and nonfunctional

The right ventricle maintains both pulmonary and systemic


The blood passes through an atrial septal defect or a dilated

oval foramen from the left to the right side of the heart,
where it mixes with the systemic venous blood.
In addition to the underdeveloped left ventricle, there are
atresia of the aortic or mitral orifice and hypoplasia of the
ascending aorta.