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Block 2 Week 2 > Cardiovascular Embryology > Flashcards

Cardiovascular Embryology Flashcards

1
Q

WHere do the majority of birth defects?

A

Congenital heart defects

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2
Q

What is more anterior, the pulmonary trunk or aorta?

A

the pulmonary trunk

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3
Q

Where do cardiac progenitor cells lie?

A

in the epiblast

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4
Q

How do cardiac progenitor cells in the epiblast migrate?

A

cranially to caudially through the primitive streak to become splachnic mesoderm

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5
Q

angiongenic cell clusters coalesce to form right and left (blank)

A

endocardial tubes

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6
Q

How does the embyro fold?

A

cephalocaudally and laterally

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7
Q

Endocardia tubes fuse via (blank)

A

programmed cell death

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8
Q

What are the four layers of the heart tube?

A

1) endocardium
2) cardiac jelly (thick acellular material made by the myocardium)
3) myocardium
4) epicardium

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9
Q

What is a thick acellular material made by the myocardium?

A

cardiac jelly

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10
Q

What makes the epicardium of the heart tube?

A

Mesothelium migrates in from septum transversum

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11
Q

What does the epicardium of the heart tube form?

A

coronary arteries

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12
Q

What will form on either side of the notochord?

A

endocardial tubes

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13
Q

Through what type of folding do the 2 endocardial tubes fuse?

A

embryonic folding

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14
Q

What are the layers of the heart tube from inside out?

A

endocardium (endothelium)-> subendothelial space (CT space)-> cardiac jelly->myocardium->epicardium

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15
Q

What allows the endocardial tube to be flexible?

A

cardiac jelly

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16
Q

What is outside the subendothelial space with invagination into subendothial space?

A

Cardiac jelly

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17
Q

(blank) veins drain the yolk sac.

A

vitelline

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18
Q

(blank) veins carry oxygen from placenta

A

umbilical

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19
Q

(blank) veins drain body wall and head.

A

common cardinal

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20
Q

The inflow and outflow tracts are connected to the heart tube before any (blank) takes place.

A

cardiac folding

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21
Q

What 3 types of veins go to the in flow tract of the heart?

A

umbilical, common cardinal, and vitelline

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22
Q

Around (blank) days, a series of expansions, constrictions and folds occur in the cardiac tube which begins the creation of the cardiac loop.

A

23

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23
Q

During the formation of the cardiac loop, what four dilations occur in the heart tube?

A

1) sinus venosus
2) primitive atrium
3) primitive ventricle
4) bulbus cordis

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24
Q

What day is the cardiac loop complete?

A

28

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25
Q

During the formation of the cardiac loop, what remains fixed in place?

A

arterial and venous ends anatomically

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26
Q

What does the distal part of the bulbus turn into?

A

the truncus arteriosus

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27
Q

What does cardiac loop formation create?

A

normal position of heart chambers and changes a single circuit system into asymmetrical system

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28
Q

When does the heart tube start beating?

A

23 days

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29
Q

The development of the heart develops from what direction?

A

inflow to outflow tract direction?

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30
Q

When does the remodeling of the sinous venosus occur?

A

day 24

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31
Q

What happens on day 24 to the sinous venosus?

A

There is a shift to the right of venous return.

1) right vitelline vein-> IVC
2) right anterior cardinal vein-> SVC
3) left sinus horn-> coronary sinus and oblique vein of the left atrium
4) right sinus horn blends into the right posterior wall of the right atrium becoming the sinus venarum

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32
Q

The right vitalline vein turns into what?

A

IVC

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33
Q

What does the right anterior cardinal vein turn into?

A

SVC

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34
Q

What does the left sinus horn turn into?

A

coronary sinus and oblique vein of left atrium

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35
Q

What does the right sinus horn turn into?

A

sins venarum

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36
Q

What all open into the sinus venarum?

A

IVC, SVC, and coronary sinus

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37
Q

the (blank) also contains crista terminalis (conducting fiber tract SA node to AV node)

A

sinus venarum

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38
Q

the pulmonary veins grow into what?

A

the smooth portion of left atrium

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39
Q

Why is it important that the sinus venarum is smooth?

A

helps with blood flow

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40
Q

What are found throughout the heart tube and are made of splachnic mesoderm?

A

endocardial cushions

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41
Q

What are endocardial cushions made out of?

A

splachnic mesoderm

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42
Q

In the coronal truncal area, the splachnic mesoderm gets an infusion of neural crest cells to create what?

A

endocardial cushions

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43
Q

Cardiac jelly creates (blank)

A

endocardial cushions

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44
Q

(blank) play a role in formation of septa and valves

A

endocardial cushions

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45
Q

endocardial cushions play a role in (blank) defects

A

cardiac

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46
Q

How is the partition of the primitive atrium formed?

A

endocardial cushions

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47
Q

Endocardial cushions from above and between the atrium forms what?

A

the septum primum

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48
Q

Is the septum primum thick or thin?

A

it is a thin membranous septum

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49
Q

What makes the septum and valves of the heart?

A

endocardial cushions

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50
Q

The septum primum only allows blood flow in what direction?

A

right to left

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51
Q

The septum primum has holes called (blank) to maintain he right to left shunt.

A

Ostium secundum

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52
Q

What is a thick muscular septum that forms to the right of the septum primum?

A

septum secundum

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53
Q

(blank) forms in septum secundum maintaining the right to left shunt/

A

foramen ovale

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54
Q

What forms ostium secundum?

A

programmed cell death

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55
Q

(blank) closes immediately after birth.

A

foramen ovale

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56
Q

HOw does the foramen ovale close after birth?

FUNCTIONAL CLOSURE

A

the pressure drop in right atrium due to absence of placental circulation and increase in left atrial pressure due to increases pulmonary venous return.

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57
Q

When is the anatomically closure?

A

3 months when the septum primum and septum secundum fuse

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58
Q

What is probe patency of the formane ovale? How often is it present? Is it of clinical importance?

A

When you have incomplete anatomical fusion of septum primum and septum secundum.
25%
No

59
Q

The opening of the septum secundum is in the inferior or superior part of the atrium?

A

inferior

60
Q

In the septum primum the openin is in the superior part of the atrium?

A

superior part

61
Q

What kind of fusion make the septum primum and septum segunda fuse together?

A

fibrous

62
Q

What kinds of things can go wrong during atrial partioning?

A

Atrial septal defects and cor triloculare biventriculare

63
Q

What atrial septal defects is most clinically significant and are males or females more susceptible to them?

A

ostium secundum defects are most clinically significant. Females get them more

64
Q

What is the absence of the interatrial septum.

A

cor triloculare biventriculare

65
Q

Endocardial cushions play a role in which heart defects?

A

ASD, VSD, transposition of great vessels, tetralogy of fallot

66
Q

Conotruncal cushions play a role in defects, what kind are they?

A

craniofacial defects and heart (include neural crest cells) i.e. if you find a face defect look and make sure not a heart defect too

67
Q

How many endocardial cushions form the partitioning of the atrioventricular canal?
what do they form exactly?

A

four
forms septum
forms bicuspid and tricuspid valves

68
Q

What are things that can go wrong with the partitioning of the atrioventricular canal?

A

persistent common atrioventricular canal and abnormal division of the canal

69
Q

Partitioning of the truncus arteriosus and the bulbus cordis involves what type of swellings/ridges?

A

truncal and conal swellings

70
Q

The truncal and conal swellings form (blank) septa dividing truncus arteriosus and bulbus cordis into aortic and pulmonary channels.

A

aorticopulmonary

71
Q

Neural crest contributes to both the truncal and conal swellings to form CT and smooth muscle of the (blank). What do the neural crest cells migrate down through?

A

aorticopulmonary septum

pharengeal arches

72
Q

How is the partitioning of the truncus arteriosus and the bulbus cordis done?

A

through spiraling, which lines up the correct outflow tract with the correct ventricle.

73
Q

What happens if you remove neural crest cells / or block their migration to the truncus arteriosus?

A

No partitioning which leads to persistant truncus arteriosis

74
Q

What is this:
- no formation of the AP septum
- a single arteriole vessel leaves the heart giving rise
to the aorta and pulmonary trunks
- usually accompanied by a defect in the interventricular septa
- clinically marked cyanosis
- can cause pulmonary hypertension (overloading of lungs)

A

persistent truncus arteriosus

75
Q

What is this?

     - occurs in about 5 out of every 10,000 births
     - failure of outflow tract openings to ALIGN with ventricles
     - clinically marked cyanosis
A

tetralogy of fallot

76
Q

What are the four components of tetralogy of fallot?

A

ventricular septal defect (primary cause)
pulmonary stenosis
overriding aorta
thickening of right ventricle

77
Q

What is this:

  • failure of the aorticopulmonary septa to develop in a spiral fashion
  • aorta/right ventricle; pulmonary trunk/left ventricle
  • clinically marked cyanosis
  • infants that survive after birth due to patent ductus arteriosus and/or ASD or VSD that allows intermixing of blood.
  • complete TGA is incompatible with life if there is no associated septal defects or patent ductus arteriosus.
A

transposition of the great vessels

78
Q

When is the primitive ventricle partitioned?

A

end of 4th week

79
Q

Where does the muscular interventricular septum develop?

A

midline on the floor of primitive ventricle

80
Q

what is between the free edge of muscular septum and aventricular cushion?

A

the Interventricular foramen

81
Q

What makes up the membranous IV septum (the baby portion of the septum)?

A
  1. right and left bulbar ridges

2. inferior AV cushions

82
Q

Ventricular septum defects are the most common cardiac congenital defect (30% of children with congenital heart disease). What are the two ways to create VSD?

A
  1. Failure of membranous IV
    septum to form – most common
    2. Muscular VSD- single or multiple
    perforations in the muscular IV
    septum
83
Q

In a neonate:
A left to right shunt will be cyanotic or acyanotic?
A right to left shunt will be cyanotic or acyanotic?

A

acyanotic

cyanotic

84
Q

WHen are the outflow tracts remodeled?

A

day 50 (way after inflow tracts)

85
Q

(blank) gives rise to the liver sinusoids (including the ductus venousus) , the portal system (portal vein, SMV, IMV) and a portion of the IVC

A

The vitelline system

86
Q

What allows the fetal blood to bypass the liver?

A

ductus venousus

87
Q

The right umbilical vein disappears and the left umbilical vein anastomoses with the (blank).

A

ductus venous

88
Q

Which umbilical vein disappears?

A

the right

89
Q

Oxygenated blood from the placenta reaches the heart via the (blank)

A

single left umbilical vein and the ductus venosus.

90
Q

What is the passage of oxygen from the placenta?

A

left umbilical vein, ductus venosus, inferior vena cave

91
Q

What makes the ductus arteriosus?

A

arch 6

92
Q

Where is arch 6?

A

on the left side

93
Q

What makes the pulmonary vessels and the ductus arteriosus?

A

arch 6

94
Q

In a neonate, patent ductus arteriosus will reverse the blood flow of and result in what?

A

pulmonary hypertension

95
Q

Ductus arteriosus usually closes within how many days?

A

1-2 days

96
Q

What can forcefully close PDA?

A

prostaglandin inhibitors

97
Q

well oxygenated blood returns from placenta via the (blank)

A

umbilical vein

98
Q

About half of the blood passes through the hepatic sinusoids/ the other half bypasses through the liver and goes through the ductus venosus into the (blank)

A

IVC

99
Q

Blood goes into the right atrium/most blood goes through the foramen ovale into the left atrium acting as a (blank), which is opposite of a neonate.

A

Right to left shunt

100
Q

Fetal circulation -Blood into the left ventricle and out the ascending aorta gives the best oxygenation to (blank)

A

head neck and upper limbs

101
Q

A small amount of blood in fetal circulation enters the (blank) where a small amount go into the lungs but the majority passes through the ductus arteriosus into the aorta creating a (blank) shunt

A

pulmonary trunk

right to left shunt

102
Q

(blank) arteries return blood to the placenta for re-oxygenation.

A

umbilical

103
Q

Parititioning of ventrical, endocardial cushion creats a (blank) septum that goes 90% of the way up to the atrium. The last 10% of the way is filled with a (blank) septum (comes from endocardial cushions from AV ledge as well as growing down of the AP septum).

A

muscualr ventricular septum

membraneous ventricular septum

104
Q

What are the most common cardiac congential defects? What is the most common cause of this cardiac congential defect?

A

ventricular septal defects

Membraneous ventricular septum

105
Q

What happens when you have transposition of great vessels? What can relieve this?

A

You get deoxygenated blood to your systemic circulation and oxygenated blood to your lungs.
A right to left shunt or surgery

106
Q

What forms the tricuspid and bicuspid valves?

A

AV canal ( also forms septum between atria and ventrices)

107
Q

Squatting is an indication of what?

A

tetrology of fallot

108
Q

NEONATES: anomalies of aortic arches (right arch, double arch, retro-esophageal right subclavian artery) and coarcationof aorta is what?

A

no shunt cardiac abnormality (acyanotic)

109
Q

Is having no shunt in neonate cyanotic or acyanotic?

A

acyanotic

110
Q

NEONATES: Having persistant ductus arteriosus, interatrial septal defects, interventricular septal defects are what kind of shunt and will is make you cyanotic or acyanotic?

A

left to right (acyanotic)

111
Q

NEONATES: Having complete transpositions of great vessels, truncus arteriosus communis and teratology is what kind of shunt and is it cyanotic?

A

right to left shunt (cyanotic)

112
Q

Heart usually develops from (blank) tract to (blank) tract

A

inflow to outflow

113
Q

Above the (blank) remodeling begins with shift to the right of the venous return for the inflow tract.

A

above the diaphragm

114
Q

During the remodeling of the inflow tract, the right vitelline veins turns into?

A

IVC

115
Q

During the remodeling of the inflow tract, the right anterior cardinal vein turns into?

A

SVC

116
Q

During the remodeling of the inflow tract, the left sinus horn turns into what?

A

coronary sinus and oblique vein of left atrium

117
Q

During the remodeling of the inflow tract, the right sinus horn blends into what?

A

right atrium to create sinus venarum

118
Q

The IVC, SVC, and coronary sinus all open in the (blank)

A

sinus venarum

119
Q

the sinus venarum contains the (blank)

A

crista terminalis (conducting fiber rtact SA node to AV node_

120
Q

What contains the conducting fiber tract from SA node to AV node

A

crista terminalis

121
Q

What does the smooth portion in the left atrium turn into?

A

pulmonary veins

122
Q

Below the diaphragm, the (blank) system gives rise to the liver sinusoids, the portal system,and a portion of the IVC.

A

vitelline system

123
Q

Below the diaphragm the (blank) disappears and the left umbilical vein anastomoses with the ductus venous.

A

right umbilical vein

124
Q

Oxygenated blood from the placenta reaches the heart via the (blank)

A

single left umbilical vein and ductus venosus

125
Q

What happens below the diaphragm?

A

Vitelline system creates portal system, liver sinusoids and portion of IVC
Right umbilial vein disappears and left umbilical vein anastomoses with ductus venous

126
Q

WHat does ductus venosus do?

A

allows oxygenated blood to bypass the liver

127
Q

The outfow tract in fetal development occurs ventrally with the (blank) and expansion of cranial end of (blank)

A

aortic arch arteries arise from the aortic sac

truncus arteriosus

128
Q

The outlfow tract in fetal development also occurs dorsally, what happens dorsally?

A

aortic arches connect to the left and right of dorsal aortae

129
Q

What will arch 3 of the aorta create?

A

carotid arteries

130
Q

how many pairs of aortic arches are there?

A

6

131
Q

Which arches does the adult arterial system develop from?

A

3,4 and 6 and R and L dorsal aortae

132
Q

Arches 3,4 and 6 develop asymmetrically and make major (blank)

A

contributions

133
Q

WHen you have a baby in utero you think what kinds of shunts?
neonates?

A

typically right to left ( formamen ovale, ductus arteriosus)

typically left to right (“ “)

134
Q

What makes up the umbilical cord?

A

2 arteries 1 vein surrounded by whartons jelly

135
Q

Describe fetal circulation:

A

umbilical cord oxygenated blood-> passes up through umbilical vein-> through ductus venosum-> IVC-> sinus venerum->foramen ovale + escaped blood form right ventricle jumps through ductus arteriosus -> aorta-> umbilical arteries return blood for reoxygenation

136
Q

When can yo hear a heart beat in utero with transvaginal ultrasound?

A

day 25

137
Q

Describe what happens to the heart at birth:

A

Birth-> open blood flow to liver, shut off shunts,, slam membranous septum against muscular in atria to shut off formane ovale.

138
Q

at birht the 3 shunts that permitted most o the blood to bypass the liver (blank)

A

cease to function

139
Q

As soon as the baby is born, the (blank) are no longer needed.

A

umbilical vessels, ductus arteriosus, formane ovale

140
Q

(blank) provides a dramatic fall in vascular resistance.

A

aeration of the lungs

141
Q

WHen you are born, what happens to your blood flow in terms of pressure and flow.

A

1) Aeration of lungs: increase in pulmonary blood flow-> increase left atrial pressure above (higher than right atrium), closing of foramen ovale,
2) constriction of ductus arteriosus
3) constriction of ductus venosus

142
Q 
What are the fetal remnants:
Umbilical arteries turn into?
Umbilica vein turn into?
ductus venosus turns into?
ductus arteriosus turns into?
formen ovale does what?
A

1) internal iliac arteries and medial umbilical
2) ligamentum teres of liver
3) ligamentum venosum
4) ligamentum arteriosum
5) becomes obliterated

143
Q

Does patent ductus arteriosus happen more often in females or males? What can close a PDA?

A

females

prostaglandin inhibitors

Block 2 Week 2 (5 decks)

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