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Peds Cards Boards > Embryology and Anatomy > Flashcards

Embryology and Anatomy Flashcards

1
Q

Gestational week when primitive embryonic heart tube forms

A

3rd week

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2
Q

Gestational week and day when heart starts beating and looping occurs

A

4th week - Day 22

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3
Q

Gestational week when AV canal divides into tricuspid and mitral valves

A

4-6 weeks

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4
Q

Gestational week when outflow tract septates into PA and aorta

A

6-8 weeks

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5
Q

What does the primary heart field become

A

Embryonic ventricle (precursor to LV) and embryonic atria (becomes atrial appendages)

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6
Q

What does the secondary heart field become

A

Proximal bulbus cordis (precursor to RV), distal bulbus cordis (infundibulum), truncoaortic sac (outflow tracts)

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7
Q

Neural crest cell abnormalities can lead to what type of defects

A

Conotruncal defects (ToF, truncus, IAA) - affect the great arteries

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8
Q

What highlights a right atrium

A
  • Septum secundum covers over septum primum on RA side
  • Broad based appendage
  • Pectinate muscles extend onto lateral RA wall
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9
Q

Borders of triangle of Koch and what does it contain

A
  • Septal leaflet of TV
  • Coronary sinus os
  • Tendon of Todaro
  • Contains the AV node
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10
Q

What highlights a left atrium

A
  • Two attachments of septum primum onto back/left of septum secundum on LA side
  • Narrow, finger like appendage
  • Pectinate muscles only in LA appendage
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11
Q

Where is the hole in a secundum ASD

A

Septum primum

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12
Q

Where is the hole in a primum ASD

A

Canal septum

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13
Q

Defining a right ventricle

A
  • Coarse trabeculations
  • Tricuspid valve - chordal attachments to the free wall and septum (SEPTOPHILIC) and tricuspid valve is more apically displaced
  • Moderator band
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14
Q

Defining a left ventricle

A
  • Fine trabeculations
  • Mitral valve - chordal attachments to the free wall only (SEPTOPHOBIC)
  • Smooth septal surface at the base
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15
Q

What does the 3rd embryonic arch become

A

Common carotid artery

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16
Q

What does the 4th embryonic arch become

A

The aortic arch on one side and the innominate artery on the other side

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17
Q

What does the 6th embryonic arch become

A

Ductus arteriosus

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18
Q

Embryonic arch process to form normal left aortic arch

A
  • Regression of the right dorsal aorta and right 6th arch
  • 4th arch persists and forms the arch, left 6th arch is the ductus
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19
Q

Embryonic arch process to form left aortic arch with aberrant right subclavian artery

A

Regression of the right 4th arch and right 6th arch

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20
Q

Embryonic arch process to form right aortic arch with mirror image branching

A

Regression of the left dorsal aorta but both 6th arches remain

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21
Q

Embryonic arch process to form right aortic arch with aberrant left subclavian artery

A
  • Regression of left 4th arch (but both 6th arches remain)
  • If right ductus persists then not a vascular ring
  • If left ductus persists then it IS a vascular ring
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22
Q

Most common symptomatic vascular ring

A

Double aortic arch

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23
Q

IAA Type A embryologic development

A
  • Regression of both dorsal aortas
  • A = AFTER all arch vessels arise (distal to L subclavian)
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24
Q

IAA Type B embryologic development

A
  • Regression of left 4th arch and right dorsal aorta
  • B = BETWEEN (interruption between L carotid and L subclavian)
  • Commonly associated with 22q11 deletion
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25
Q

IAA Type C embryologic development

A
  • Break in the trunco-aortic sac and regression of right dorsal aorta
  • C = CAROTIDS (interruption between R carotid and L carotid)
26
Q

Asplenia (right sidedness) segmental anatomy abnormalities

A
  • Almost 100% complete AV canal
  • Commonly have PS/PA
  • TAPVR
  • Bilateral SVC with LSVC directly to LA, can have absent coronary sinus
  • Bilateral sinus nodes
  • Descending aorta and IVC on the same side of the vertebral column
  • High incidence of bowel malrotation
  • Liver midline with two mirror image right lobes
27
Q

Polysplenia (left sidedness) segmental anatomy abnormalities

A
  • 2/3 patients with AV canal
  • Most have normal VA connections but can have sub-aortic or aortic stenosis
  • Ipsilateral PV drainage
  • Bilateral SVCs with LSVC to CS
  • Interrupted IVC
  • Complete heart block
28
Q

Most reliable way to distinguish mitral vs tricuspid valve

A

Level of attachment at the cardiac crux

29
Q

Associations with left juxtaposition of the atrial appendage

A

Abnormal ventriculoarterial connections

30
Q

Associations with right juxtaposition of the atrial appendage

A

Simpler lesions like ASD, single SA node

31
Q

Valve located at the entrance of the IVC

A

Eustachian valve

32
Q

Valve remnant at the os of the coronary sinus

A

Thebesian valve

33
Q

Fine filamentous network that represents persistent of the valves of the sinus venosus

A

Chiari network
– Directs blood from IVC and SVC across the PFO
– In normal patients, this regresses to form the crista terminalis

34
Q

Embryologic structure that gives rise to R SVC

A

R anterior cardinal vein and R common cardinal vein

35
Q

Embryologic structure that gives rise to L SVC

A

L anterior cardinal vein

36
Q

Ductus venosus remnant

A

Ligamentum venosum

37
Q

Umbilical vein remnant

A

Round ligament of the liver

38
Q

Position of the AV node in tricuspid atresia

A
  • Floor of the blind right atrium
  • Bundle of His then courses onto the crest of the intraventricular septum and runs posterior to the VSD rim
39
Q

Most common asymptomatic aortic arch anomaly

A

Left arch with aberrant right subclavian (0.5% of the general population)

40
Q

What is Uhl anomaly

A

Partial of complete absence of the RV myocardium leading to thinned out myocardium

41
Q

Definition of overriding AV valve

A

Empties into 2 ventricles and is always associated with a malalignment VSD

42
Q

What is a straddling valve

A

Involves anomalous insertion of the chordae tendinae - has to have a VSD but may not be malalignment type

43
Q

What structures pass under the transverse arch

A

RPA and left bronchus

44
Q

Most common great artery relationship in DORV

A

Side by side (aorta to the right of the

45
Q

Most common associated lesion with DORV

A
  • Pulmonary stenosis (seen in 50% of patients)
  • Next is ASD (25%)
46
Q

What is a parachute mitral valve

A

All chordal attachments to a single papillary muscle

47
Q

What is a mitral arcade

A

Valve leaflets attach directly to the papillary muscle (absent or short chordae)

48
Q

What type of cells are in the last 1-3 cm of pulmonary veins

A

Contractile cardiac myocytes which helps to inhibit retrograde flow in atrial systole but can be a source of Afib

49
Q

Coronary artery supply of the posterior medial papillary muscle

A

Right coronary artery (also supplies the inferior wall of the LV)

50
Q

Name of the valve that drains the great cardiac vein

A

Vieussens valve
- Bicuspid valve located at the site of the cardiac vein that drains with the coronary sinus

51
Q

Most common coronary anomaly in otherwise normal hearts

A

Anomalous left circumflex from the right main coronary artery

51
Q

AV nodal artery arises from which coronary

A

90% of the time from the RCA
10% from the left circumflex

52
Q

Normal branching pattern of PAs relative to the bronchus

A
  • RPA travels anterior to the right upper lobe bronchus
  • LPA travels posterior to the left upper lobe bronchus
53
Q

Characteristics of fibromas

A
  • Single, firm intramural tumors involving the ventricular free wall or septum
  • Frequently present with ventricular arrhythmias
54
Q

Characteristics of rhabdomyomas

A
  • Well-circumscribed, non-capsulated intramural or intracavitary lesion
  • Most commonly in the ventricles but can be anywhere and also usually have multiple
55
Q

Characteristics of myxoma

A
  • Pedunculated and friable
  • Occur most commonly in the LA
  • Associated with cardiac obstruction (80%), embolism (70%) and systemic illness (60%)
56
Q

Hi Kamel

A

<3

57
Q

What is the ligament of Marshall

A

Small fibrous ridge traveling anterior to the pulmonary veins and left pulmonary artery

Represents residual of the left sided superior vena cava

58
Q

What does septum primum and septum secundum become

A
  • Primum: valve of the fossa ovalis
  • Secundum: limbus of the fossa ovalis
59
Q

What is the transverse sinus

A

Tunnel shaped structure that runs between the anterior/superior walls of the atria and posterior/inferior to the great vessels

Can be used to help find remnant of pulmonary artery in pulmonary atresia

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