Embrology & Anatomy Flashcards
The bulbus cordis gives rise to
Proximal bulbus cordis to the RV
Distal bulbus cordis outflow tracts
The primitive ventricle gives rise to
The LV
In juxtaposition of the atrial appenange the atrial appendages are _____ of the outflow tracts
This is commonly seen in association with underdeveloped R or L sided strucures
To the L of outflow tracts
Believed to be 2/2 to an arrest in development in this early stage after dlooping of the primitive heart tube. Because the development of thr RV lags behind the LV, we commonly see this associated with
Commonly associated with an underdeveloped R side and both outflow tracts arising from the RV
The common atria initally drain to what structure
-bulbous cordis or primtive ventricle
AV canal drains into the primitive ventricle
Which is why double inlet left ventricle is thought to be 2/2 an arrest in development at 4-6 weeks of development
The flow going thru the heart at this point is atria, LV, bulbous cord is, outflow tracts
The truncal aortic sac gives rise to
The great arteries
What normal stage of development causes the AV valve to be positioned over both ventricles and form two distinct AV valves
Growth of thr RV
What does the 1° heart field give rise to?
D embryonic ventricle —>lv and atria (appendages)
What does the secondary heart field give his to?
Bulbus cordis
Proximal becomes RV
Distal becomes truncoaortic sacs or outflow tracts
What genetic deletion affects the neural crest cells?
22q11
What happens with abnormal migration of the neural crest cells?
Abnormal development of the great arteries
ToF,IAA
Abnormal looping of the heart results in what abnormality?
L-TGAor ccTGA
Abnormalities in the dorsal meserchymal protrusion will lead to?
Common AV canal defects
The limbus of the fossa oval is can be found in which cardiac chamber
RA
What is the eustachian valve and where is it found
Entrance of IVC to RA, important structure fetally to direct oxygenated blood Across the ASD to the LA
What is the thebesian valve and where is it found
Opening of the coronary sinus to the ra
A broad based appendage with pectinate muscle extending out is going to be
RA appendage
Describe where pectinate muscle can be found within the LA
Confined to the finger like LA appendage
The flap valve of the fossa ovalis is found in which cardiac chamber
LA—the two attachments of the septum primum onto the septum secundum
A secundum ASD is 2/2 hole in septum …
A primum asd is 2/2 hole in septum…
When a vein overrides the ASD you get
Secundum asd-hole in septum primum
2) canal septum
3) sinus venous defect
What is the difference between an overriding vs straddling AV valve?
Override—AV valve annulus Empties into both ventricles, normal chordal attachment
Straddling—anomalous chordal attachments to both ventricles
What are the other terms for a permemibranous VSD?
Peri-membranous
Central
Conoventricular
Where does the conduction tissue run along peri-membranous vids?
Posterior-inferior rim of VSD
So the surgeon has to be careful below and behind the VSD
Where does the conduction system run with an inlet VSD?
Posterior or inferior rim
Like PM VSD, surgeon must watch below and beneath defect
What type of VSD is found between the Y of the septal band?
Outlet or juxtarterial doubly committed or conoseptal hypoplasia VSD
Aortic and pulmonary valve fibrous continuity 2/2 hypoplastic conal/infundibular septum
High risk for RCC prolapse therefore presence of defect is indication for closure
In addition to outlet VSD where the infundibular or conal septum is hypoplastic, what additional angle can occur with the conal septal
Anterior or posterior malalignment
So hole is in the Y of the septal band and the conus is deviated anteriorly or posteriorly
What are the two rules for assigning arteries to ventricles
1) ao to mitral fibrous continuity (Nml heart), Ao is assigned to the aorta
2) the 50% rule to determine which ventricle the great artery is more committed to
Arch sidedness refers to where the transfer arch crosses what a atomic structure
Bronchus
When thinking about an aberrant Subclavian artery what is its relation to arch sidedness and the esophagus?
Retroesophagel
Aberrant subclavian ARE ALWAYS opposite the side of the arch
Where do embryonic arches arise from?
Paired pharyngeal arches come front truncoaortic sac and dive posteriorly towards the dorsal aorta
Some arches appear and the regress and a certain combination of them persist
What does the 3rd arch give rise to
Common carotid artery, bridge that connects the external and internal carotids
Which embryonic arch gives rise to THE aortic arch
4th arch
On one side connects the carotid to subclavian forming the innominaye artery
On the other side it is THE ARCH
What does the 6th embryonic arch give rise to
Ductus arteriousus
What arch do the branch pas arise from
NONE! They grow out from the lungs and toward the truncoaortic sac to join the mpa
What arches give rise to the distal subclavian artery
None—-peripheral artery that arises from the 7th intersegmental artery and migrates upward to the arch
What arch involutes in L aortic arch with aberrant R subclavian
R 4th and 6th
Complete involution of R 4th means no R innominate
RAA with mirror image branching what side is the duct
regression of the L dorsal aorta
You can have either r or l 6th arch persist if L persists the ducts will arise from The base of the L innominate
How can a RAA with aberrant L subclavian form a vascular ring
If there is either persistence of the L PDA or a ligamentium
How do you know if there is a ligamentium
Fetally it was a Ductus with R to L flow which results in an out pitching at the base of the L subclavian which is also known as a diverticulum of kommerell
What is the most common symptomatic vascular ring
Double aortic arch
What is the second most common type of symptomatic vascular ring
RAA with aberrant L and L ligamentium or diverticulum of kommerell noted on mri
Typically not symptomatic, picked up more now bc of fetals
Seen in 22q11Deletion
Clues that you have a vascular ring
3 Ds—diverticulum —seen @base of anomalous subclavian
Dimple—protrusion seen in double aortic arch
Descending aorta—circumflex aortic arch, or descending aorta on the opposite side of your aortic arch
That is a vascular ring
When you have a double aortic arch which arch is the most commonly dominant
R
If you see an interrupted arch in the setting of an Ao window what type of interruption is it?
Type A
After all the head and neck vessels regression of bilateral dorsal aortas
What type of arch interruption is most common with Digeorge syndrome? Which extremities will be fully saturated
Type B between the L carotid and the L subclavian
The RUE and head and neck will be fully saturated
LUE and b/l lower extremity will be supplied by the descending aorta and therefore be desaturated
If you have a neonate that comes in with poor pulse to all four extremities, closing duct, low saturation in all extremities and a normal saturation to the head and neck what is the anatomy
Type B interrupted arch with an aberrant R subclavian
Therefore all four extremities are arising from ductus and head and neck and supplied by the native arch
At what week (Post menstrual) does looping occur
3 weeks
The triangle of Koch is defined by what an atomic landmarks
OS of the coronary sinus inferiorly
Tendon of todaro Posteriorly
Tv annulus anteriorly
The av node sits within this
Describe an arcade mitral valve
Abnormally short chordea or direct chordal attachments to papillae muscle
A cleft in the mitral leaflet is direct toward the outflow tract NOT the ventricular septum, this is seen more commonly in AVSD or isolated mitral cleft
Isolated mitral cleft
