Anatomy of Bloodflow Through Fetal Heart Flashcards

1
Q

what are the black arrows

A

valve flaps of the atrio-ventricular or tricuspid valve

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2
Q

what are the red and pink arrows

A

red: chordea tendineae of tricuspid valve
pink: papillary muscles

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3
Q

what is the structure of the right AV (tricuspid) valve

A

3 cusps: chordae tendineae and papillary muscles/fibrous annular ring support

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4
Q

what is the action of the AV valve

A

passive/prevents backflow of blood into atrium at systole

1st heart sound lub = closure of right and left AV valves

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5
Q

what are the structures of the right ventricle

A
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6
Q

list 5 anatomical features of the right ventricle

A
  1. wall: endocardium, myocardium and epicardium
  2. trabecular septomarginalis: distinct feature of right atrium –> carries the short circuiting impulse to the walls –> related to the papillary muscles which will contract before the walls of the heart contract to prepare to hold the valves
  3. trabecular carneae: elevation of wall –> act like pectinate muscle –> dampen out the turbulence of blood
  4. pulmonary trunk exits RV on the left lateral side of the heart
  5. walls are smooth and shiny
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7
Q

what are the structures (transverse section through R&L ventricles)

A
  1. most cranial point
  2. right ventricle
  3. interventricular septum
  4. left ventricle
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8
Q

identify the labels and describe how blood flows through the right side

A

right ventricle forms the cranial margin of heart

blood exits RV through pulmonary trunk (on left lateral side) through pulmonary semi-lunar valve

pulmonary trunk bifurcates into L&R pulmonary arteries which enter root of L&R lung

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9
Q

list the anatomical features of the pulmonary semilunar valve

A
  1. at junction of RV and pulmonary trunk
  2. second heart sound ‘dub’ = closure of pulmonary and aortic semi lunar valves
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10
Q

what is the ligamentum arteriosum

A

ligament linking the pulmonary trunk and aorta

fetal remnant of the ductus arteriosus

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11
Q

what are these structures

A
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12
Q

describe the blood flow through the left side of the heart

A
  1. oxygenated blood enters left atrium (& auricle) from the lungs via pulmonary veins –> mitral valve (bicuspid) or left AV valve –> left ventricle –> aortic semi-lunar valve guards entrance to aorta –> aorta exits middle of base of heart
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13
Q

what ventricle forms the base of the heart

A

left –> very thick wall

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14
Q

what are the anatomical features of the mitral valve

A

2 cusps

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15
Q

what are the structures of left atrium and ventricle

A
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16
Q

what are the structures (dorsal view of heart after removal of atria)

A
  1. right atrioventricular valve
  2. left atrioventricular valve
  3. aortic valve
  4. pulmonary valve
  5. left coronary artery
  6. righ coronary artery
    cr: cranial
17
Q

what are the structures

A

A: mitral valve

B: semi-lunar valve

C: coronary circulation

18
Q

what is the puncta maxima

A

points on the chest wall where heart sounds are heard best

left thorax: between 3,4,5th intercostal space

right thorax: tricuspid 4th intercostal space

19
Q

what are the structures of the thorax

A
  1. cranial extent of heart
  2. caudal extend of heart
  3. basal border of lung
  4. line of pleural reflection
  5. caudal border of lung percussion area shown on right side
20
Q

what are the structures shown here

A
  1. right auricle
  2. left atrium
  3. left atrioventricular valve
  4. interventricular septum
  5. aorta
21
Q

what are the structures of the early fetal heart

A

placenta –> maternal and fetal blood flow coming close to each other

the umbilical vein has nutritious and highly oxygenated blood

returns deoxygenated blood to the placenta

22
Q

what is the 1st step in the formation of the 4 chambered heart

A

subdivision of the channel between the primitive atrium and ventricle

2 chambered heart recieving and distributing areas that is segmented in the middle –> partitions coming from above and below

23
Q

what is the second step in the formation of the 4 chambered heart

A

subdivision of the primitive ventricle continues –> interventricular septum

the atrioventricular channel splits into two-av canal cushions

the interatrial septum starts to form but is never complete

24
Q

what is the third step in the formation of the 4 chambered heart

A

ventricles are now separate

AV valves form

the atria continue to intercommunicate (RA to LA) via foramen ovale

25
Q

what is the distribution of blood in the fetus before birth

A

lungs not functional –> high resistance pulmonary circulation

blood flows mainly to the low resistance systemic circulation and the placenta

2 shunts make this possible –> foramen ovale, ductus arteriosus

26
Q

what other shunt maximizes the PO2 of blood entering the heart from the placenta

A

ductus venosus in the liver

27
Q

what is the function of the ductus venosus

A

blood moves from the umbilicus towards the liver via umbilical vein (green) –> shunt in liver (ductus venosus) prevents mixing of oxygenated blood from placenta (red) with fetal hepatic venous return from gut (blue) –> blood enters right atrium via caudal vena cava (orange)

28
Q

what is the function of the foramen ovale

A

oxygenated blood entering right atrium (RA) passes through one way valve –> foramen ovale –> diverted into LA-LV-aorta (orange) –> into aorta –> preferential delivery of blood with high PO2 leaving left ventricle to heart and brain –> blood entering RA from cranial vena cava flows into RV (as in adult) (dark blue)

**a passageway between right and left atrium

don’t want the blood to go into the right ventricle –> goes through the hole and into the left side where it will go through the aorta to head

the caudal vena cava –> carries highly oxygenated blood

cranial vena cava brings deoxygenated blood into the right atrium –> there is a mixing of blood in the right atrium

the cranial vena cava deoxygenated blood is forced into the right ventricle –> bypassing the mixing –> goes to the pulmonary trunk

29
Q

what is the function of the ductus arteriosus

A

2nd shunt links pulmonary trunk to aorta –> allows blood entering right ventricle to bypass the lungs and pass into the aorta and eventually bakc to the placenta –> exercises right ventricle in prep for delivering entire output to lungs after birth

**mixes with deoxygenated blood here from the aorta –> nourishes other areas of the body before returning to the placenta

30
Q

how does the ductus venosus close and what are defects associated with it

A

often persists until birth in carnivores, ruminants and humans

defect: persistent patent ductus venosus

portacaval shunt: portal blood bypasses liver

31
Q

how does the foramen ovale close and what are defects associated with it

A

lung inflation causes increased pressure in left atrium –> functional closure before anatomical closure –> scar right atrium –> forms scar tissue in interatrial wall (fossa ovalis)

defect: patent foramen ovale not problematic

32
Q

how does the ductus arteriosus close and what are defects associated with it

A

inflation lungs causes turbulence –> smooth muscle constriction –> anatomical closure –> forms ligamentum arteriosum

defect: patent ductus arteriosus –> serious characteristic machinery murmur

33
Q

what are the 3 main categories of congenital heart defects

A
  1. failure of closure of fetal structures (foramen ovale, ductus arteriosus –> PDA, ductus venosus –> liver)
  2. septal defects (interventricular septum)
  3. great vessel defects –> defects of outflow tracts –> aortic or pulmonary valves
    - dysplasia - malformed or disorderly
    - stenosis - decreased lumen size
    - malposition/fusion of great vessels