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PBL Test 2 - Embryo: The Cardiovascular System
Embryology of the cardiovascular system
185
Medical
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10/31/2010

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Term
What is the first major system to function in the embryo?
Definition
The cardiovascular system!
Term
The heart starts to function at the beginning of the ___th week.
Definition
4
Term
The primordial heart and vascular system appear in the middle of which week?
Definition
3
Term
The CV system is derived mainly from what 3 components?
Definition
splanchnic mesoderm, paraxial and lateral mesoderm near the otic placodes, neural crest cells from the region between the otic vesicles and the caudal limits of the 3rd pair of somites
Term
The earliest sign of the heart is the appearance of paired ____________ strands, called __________ cords, during week __.
Definition
endothelial, angioblastic, 3
Term
Angioblastic cords fuse to form ______________________, which fuse to form the tubular heart late in week __.
Definition
endocardial heart tubes, 3
Term
When does the heart begins to beat?
Definition
22 to 23 days
Term
What appears to stimulate early formation of the heart?
Definition
An inductive influence from the embryonic endoderm
Term
What are the 3 paired veins that drain into the tubular heart of a 4-week-old embryo?
Definition
Vitelline, umbilical and cardinal veins
Term
Which embryonic veins return poorly oxygenated blood?
Definition
Vitelline and cardinal
Term
Which embryonic veins drain well oxygenated blood?
Definition
Umbilical
Term
What is the yolk stalk?
Definition
The narrow tube connecting the yolk sac with the embryo
Term
Which veins follow the yolk stalk into the embryo, pass through the septum transversum and enter the sinus venosus?
Definition
vitelline veins
Term
As the liver primordium grows into the septum transversum, what structures anastomose around pre-existing endothelium-lined spaces? These spaces are the primordium of what? They become linked to which veins?
Definition
hepatic cords, the hepatic sinusoids of the liver, vitelline veins
Term
Remains of the right vitelline vein in the region of the developing liver go on to form...
Definition
the hepatic veins
Term
What does the portal vein develop from?
Definition
An anastomotic network formed by the vitelline veins around the duodenum.
Term
___________ veins run on each side of the _________ and carry well-oxygenated blood from the ________ to the ____________.
Definition
Umbilical, liver, placenta, sinus venosus
Term
As the liver develops, the umbilical veins lose their connection with the ______ and empty into the ______.
Definition
heart, liver
Term
The right ________ vein disappears at the end of the embryonic period, leaving the _____________ vein as the only vessel carrying well-oxygenated blood from the ________ to the ________.
Definition
umbilical, left umbilical, placenta, embryo
Term
The persistent part of the left umbilical vein becomes the _________ vein, which carries all blood from ________ to ________.
Definition
umbilical, placenta, embryo
Term
What large venous shunt develops within the liver? What does it connect?
Definition
ductus venosus, umbilical vein to the IVC (bypassing the capillary networks of the liver)
Term
What veins are the main venous drainage system of the embryo?
Definition
Cardinal veins
Term
The anterior and posterior cardinal veins join the _____________, which enter the ____________.
Definition
Common cardinal vein, sinus venosus
Term
During the eighth week, what structure develops that eventually becomes a large vein in the thorax?
Definition
An oblique anastamosis between anterior cardinal veins, to shunt blood from left to right anterior cardinal veins. Eventually becomes left brachiocephalic vein.
Term
The SVC forms from...
Definition
The right anterior cardinal vein and right common cardinal vein.
Term
The posterior cardinal veins develop primarily as vessels of the _________ and large disappear.
Definition
mesonephroi
Term
What are the only adult derivatives of the posterior cardinal vein?
Definition
Root of azygos vein and common iliac veins
Term
Which veins gradually replace and supplement the posterior cardinal veins?
Definition
Subcardinal and supracardinal veins
Term
Subcardinal veins are connected to each other through _____________ and with the posterior cardinal veins through the ______________.
Definition
Subcardinal anastamosis, mesonephric sinusoids.
Term
What do the subcardinal veins form (in the adult)?
Definition
stem of left suprarenal vein, gonadal veins, segment of the IVC
Term
What is the last pair of vessels to develop? They become disrupted in what region?
Definition
The supracardinal veins, region of the kidneys
Term
Cranial to the kidney region, the _____ veins become united by an anastamosis that is represented in the adult by the _________ and ________ veins.
Definition
supracardinal, azygos and hemiazygos veins
Term
Caudal to the kidneys, what do the left and right supracardinal veins form?
Definition
left degenerates, right forms the inferior part of the IVC
Term
What are the 4 main segments of the IVC?
Definition
Hepatic, prerenal, renal, postrenal
Term
What is the first segment (proximal) of the IVC, and what is it derived from?
Definition
The hepatic segment, from the hepatic vein (proximal part of right vitelline vein) and hepatic sinusoids
Term
What is the second segment of the IVC, and what is it derived from?
Definition
Prerenal segment, from the right subcardinal vein
Term
What is the third segment of the IVC, and what is it derived from?
Definition
The renal segment, from the subcardinal-supracardinal anastamosis
Term
What is the last segment (distal) of the IVC, and what is it derived from?
Definition
Postrenal segment, from the right supracardinal vein
Term
What is the most common anomaly of the venae cavae?
Definition
A persistent left SVC
Term
Where does a persistent left SVC drain?
Definition
Into the right atrium via the coronary sinus
Term
What is the most common anomaly of the IVC? How is blood flow changed?
Definition
Interruption of the abdominal course, with blood draining from the lower half of the body through the azygos system
Term
Persistence of which vein results in a left SVC, and therefore a double SVC?
Definition
Left anterior cardinal vein
Term
With a double SVC, what structure is usually small or absent?
Definition
The anastamosis that usually forms the left brachiocephalic vein
Term
With a left SVC (no right SVC), blood from the right side of the body is carried by which vein, to the left SVC, to where?
Definition
the brachiocephalic vein to the SVC to the coronary sinus
Term
What would cause blood from the inferior parts of the body to drain into the right atrium via the azygos and hemiazygos system? What opens separately into the right atrium?
Definition
Failure of the hepatic segment of the IVC to form, the hepatic veins open separately into the right atrium
Term
If an anastamosis fails to develop between primitive veins of the trunk, the inferior part of the left supracardinal vein may persist as a second...
Definition
IVC.
Term
When do the pharyngeal arches form? Which arteries supply them? Where do they arise and terminate?
Definition
4th and 5th weeks, aortic arches, arise from aortic sac, terminate in dorsal aortae
Term
Which arteries carry blood to the somites and their derivatives? Where do these arteries come from?
Definition
intersegmental arteries, they are branches of the dorsal aorta
Term
Which arteries join to form the vertebral arteries in the neck?
Definition
dorsal intersegmental arteries in the neck
Term
In the thorax, dorsal intersegmental arteries persist as...
Definition
intercostal arteries
Term
Most of the dorsal intercostal arteries in the abdomen become...
Definition
lumbar arteries
Term
The common iliac arteries are remnants of...
Definition
the 5th pair of lumbar intersegmental arteries
Term
In the sacral region, the intersegmental arteries form the...
Definition
lateral sacral arteries
Term
Which artery becomes the median sacral artery?
Definition
The caudal end of the dorsal aorta
Term
The unpaired ventral branches of the dorsal aorta supply...
Definition
the yolk sac, allantois, and chorion
Term
Which arteries pass to the yolk sac, and later the primordial gut?
Definition
Vitelline arteries
Term
3 vitelline arteries remain as the...
Definition
celiac artery, superior and inferior mesenteric arteries
Term
Which paired arteries pass through the connecting stalk and become continuous with vessels in the chorion?
Definition
The umbilical arteries
Term
What kind of blood do the umbilical arteries carry? From where to where?
Definition
Poorly oxygenated, from the embryo to the placenta
Term
Proximal parts of the umbilical arteries become...
Definition
internal iliac and superior vesicle arteries
Term
What forms the medial umbilical ligaments?
Definition
Obliterated distal parts of umbilical arteries
Term
The primordium of the heart is first evident at...
Definition
18 days
Term
In the _______ area, splanchnic mesenchumal cenns ventral to the pericardial coelom aggregate and arrange themselves into __________ cords.
Definition
cardiogenic, angioblastic
Term
Fusion of the endocardial tubes begins at which end?
Definition
cranial
Term
What is the external layer of the embryonic heart, which is formed from splanchnic mesoderm surrounding the pericardial coelom?
Definition
primordial myocardium
Term
The developing heart's thin endothelial tube is separated from the primordial myocardium by...
Definition
cardiac jelly
Term
What does the endothelial tube of the early heart become?
Definition
endocardium
Term
What is the epicardium derived from?
Definition
mesothelial cells that arise from the external surface of the sinus venosus and spread over the myocardium
Term
What tubular structure is continuous cranially with the aortic sac?
Definition
truncus arteriosus
Term
What is the arterial end of the early heart fixed by? The venous end?
Definition
pharyngeal arches, septum transversum
Term
Which areas of the early heart grow fastest, causing the loop to form?
Definition
bulbis cordis and the ventricle
Term
As the primordial heart bends, the atrium and sinus venosus come to lie dorsal to the...
Definition
truncus arteriosus, bulbus cordis and ventricle
Term
The heart is initially suspended from the dorsal wall by a mesentary, the...
Definition
dorsal mesocardium
Term
The central part of the dorsal mesocardium undergoes what change? What does this form?
Definition
degenerates, forming the transverse pericardial sinus
Term
What is the origin of the INITIAL contractions of the heart?
Definition
myogenic origin
Term
In the primordial heart, contractions occur in waves that begin in the...
Definition
sinus venosus
Term
By the end of the 4th week, coordinated contractions of the heart result in...
Definition
unidirectional flow
Term
Describe the movement of blood through the primordial heart
Definition
sinus venosus -> sinoatrial valve -> primordial atrium -> atrioventricular canal -> primordial ventricle -> bulbis cordis -> truncus arteriosus -> aortic sac -> aortic arches
Term
Septum primum fuses to the _______, closing the ______.
Definition
endocardial cushions, foramen primum
Term
The valve of the foramen ovale is derived from the...
Definition
septum primum
Term
Partitioning of the heart begins around the middle of the ______ week and is essentially completes by the end of the ______ week
Definition
4th, 5th
Term
Toward the end of the 4th week, what forms on the dorsal and ventral walls of the AV canal?
Definition
endocardial cushions
Term
Endocardial cushions are invaded by ______ cells during the ____th week, approach each other and fuse, dividing the AV canal into...
Definition
mesenchymal, 5th, left and right AV canals
Term
What does the foramen primum do?
Definition
allows oxygenated blood to pass from right to left atrium
Term
The septum primum fuses with fused endocardial cushions to form a...
Definition
primordial AV septum
Term
Where does the foramen secundum come from?
Definition
Perforations produced by programmed cell death in the central part of the septum primum
Term
How is the foramen primum obliterated?
Definition
The free edge of the septum primum fuses with the left side of the endocardial cushions
Term
The septum secundum grows immediately to the ______ of the septum primum
Definition
right
Term
What forms an incomplete partition between the atria, leading to the formation of the foramen ovale?
Definition
septum secundum
Term
What forms the valve of the foramen ovale?
Definition
the remaining part of the septum primum
Term
Progressive enlargement of the right horn of the sinus venosus results from which two left-to-right shunts of blood?
Definition
1) results from transformation of vitelline and umbilical veins
2) occurs when the oblique anastamosis connects anterior cardinal veins (eventually becoming left brachiocephalic vein)
Term
By the end of the ____th week, the right horn of the sinus venosus is _______ than the left.
Definition
4, larger
Term
The left horn of the sinus venosus becomes the...
Definition
coronary sinus
Term
What eventually happens to the right horn of the sinus venosus?
Definition
it is incorporated into the wall of the right atrium
Term
The smooth part of the right atrial wall is derived from what? What is it called?
Definition
sinus venosus, sinus venarum
Term
What structure represents the cranial part of the right sinoatrial valve?
Definition
crista terminalis
Term
The caudal part of the right sinoatrial valve forms the valves of the...
Definition
IVC and coronary sinus
Term
What becomes of the left sinoatrial valve?
Definition
It fuses with the septum secundum and is incorporated into the IA septum
Term
Most of the wall of the left atrium is smooth because it is formed by incorporation of the...
Definition
primordial pulmonary vein
Term
The primordial pulmonary vein develops as an outgrowth of the dorsal...
Definition
atrial wall
Term
The small left auricle is derived from...
Definition
the primordial atrium
Term
In total anomalous pulmonary venous connections, where do the pulmonary veins open?
Definition
Into the right atrium
Term
What is the first indication of the separation of the primordial ventricle?
Definition
The primordial IV septum
Term
The medial walls of the enlarging ventricles approach each other and fuse to form the primordium of the...
Definition
muscular part of the IV septum
Term
The IV foramen usually closes by the end of which week? How?
Definition
7th, the bulbar ridges fuse with the endocardial cushion
Term
Closure of the IV foramen and formation of the membranous part of the IV septum results from fusion of tissues from what 3 sources?
Definition
right and left bulbar ridges, endocardial cushion
Term
What is the membranous part of the IV septum derived from?
Definition
an extension of tissue from the right side of the endocardial cushion to the muscular part of the IV septum
Term
The tissue forming the membranous part of the IV septum fuses with what?
Definition
The aorticopulmonary septum and the muscular part of the IV septum
Term
What happens to establish the communication of pulmonary trunk and right ventricle and aorta with the left ventricle?
Definition
closure of the IV foramen and formation of the membranous part of the IV septum
Term
The fetus is at risk of heart disease when the HR is lower than...
Definition
80 bpm
Term
During the 5th week, proliferation of mesenchymal cells in the walls of the bulbus cordis results in...
Definition
formation of bulbar ridges
Term
What ridges are continuous with the bulbar ridges?
Definition
truncal ridges
Term
The bulbar and truncal ______ are derived largely from what types of cells?
Definition
ridges, neural crest cells
Term
As neural crest cells migrate to reach the ______ and ______ ridges, they undergo what movement?
Definition
bulbar, truncal, 180 degree spiraling
Term
The spiraling of the bulbar and truncal ridges results in formation of ______________ when the ridges fuse.
Definition
a spiral aorticopulmonary septum
Term
The spiral aorticopulmonary septum divides what?
Definition
Divides the bulbus cordis and truncus arteriosus into the aorta and the pulmonary trunk
Term
What are the adult representations of the bulbus cordis?
Definition
the conus arteriosus and the aortic vestibule
Term
What begins to develop from 3 swellings of subendocardial tissue around the orifices of the aorta and pulmonary trunk when partitioning of the truncus arteriosus is nearly complete?
Definition
the semilunar valves
Term
The SA node develops during which week? Where is it originally, and where is it incorporated into?
Definition
5th week, in the right wall of the sinus venosus, incorp. into the wall of the right atrium
Term
What forms the AV node and bundle?
Definition
Cells from the left wall of the truncus arteriosus, found in the base of the IA septum just anterior to the opening of the coronary sinus, plus cells from the AV region
Term
What grows in from the epicardium, separating the muscle of the atria from that of the ventricles, and forms part of the cardiac skeleton?
Definition
a band of connective tissue
Term
SIDS may be caused by abnormalities in the _________ system, or a developmental abnormality on the _______.
Definition
conduction, brain stem
Term
What is the most common cause of postnatal death in developed countries, accounting for 40-50% of infant deaths during the 1st year?
Definition
SIDS
Term
Most CHDs are thought to be caused by multiple factors, genetic and environmental, known as...
Definition
multifactorial inheritance
Term
2D echos can detect fetal CHDs as early as...
Definition
the 17th or 18th week
Term
If the heart tube bends to the left instead of the right, what is this called? What is the associates transposition? What are the two main types of this problem? Which is worse?
Definition
Dextrocardia, heart and great vessels are reversed as a mirror image, with or without situs inversus, isolated is worse
Term
What is the condition of having the heart in an abnormal location, like exposed on the surface of the thorax? Why does this happen?
Definition
ectopia cordis, faulty fusion of the lateral folds during the 4th week
Term
ASDs are more common in who? What is the most common form? What type is present in up to 25% of people?
Definition
females, patent FO, probe patent FO
Term
What are the 4 clinically significant types of ASDs?
Definition
ostium secundum defect, endocardial cushion defect with ostium primum defect, sinus venosus defect, common atrium
Term
Ostium secondum ASDs include both defects in which structures? More common in females or males?
Definition
septum primum and secundum, females
Term
Which type of ASD is well tolerated during childhood but causes symptoms like pulmonary HTN in the 30s or later?
Definition
ostium secundum ASDs
Term
If the septum primum does not fuse with endocardial cushions, what sort of defect results? There is a patent...
Definition
Endocardial cushion defect with ostium primum ASD, patent foramen primum
Term
If fusion of the endocardial cushions fails to occur, what kind of defect results? This is present in ___% of people with _______.
Definition
AV canal, 20% of Down syndrome
Term
Sinus venosus defects result from what? What is it associated with?
Definition
the incomplete absorption of the SV into the right atrium, partial anomalous pulmonary venous connections
Term
What is the rare cardiac defect in which the IA septum is absent? Why does this happen?
Definition
common atrium, result of failure of the septum primum and septum secundum to develop
Term
What type is the most common type of CHD, accounting for more than 25% of defects?
Definition
VSDs
Term
Membranous VSD involves incomplete closure of the IV foramen resulting from failure of the...
Definition
membranous part of the IV septum to develop
Term
Large VSDs with excessive pulmonary blood flow can result in what problems early in infancy?
Definition
pulmonary HTN, dyspnea, cardiac failure
Term
If there are multiple small defects in the muscular IV septum, this is called...
Definition
Swiss cheese VSD
Term
What type of defect probably occurs due to excessive cavitation of myocardial tissue during the formation of the ventricular walls?
Definition
Muscular VSDs
Term
Transposition of the great arteries and a rudimentary outlet chamber are present in most infants with this severe type of CHD.
Definition
Single ventricle, or common ventricle
Term
What defect results from failure of the truncal ridges and aorticopulmonary septum to develop normally?
Definition
persistent TA
Term
What is always present with the TA anomaly and is overridden by the TA?
Definition
a VSD
Term
What is the most common type of TA?
Definition
a single arterial vessel that branches to form the pulmonary trunk and ascending aorta
Term
What is an aorticopulmonary septal defect?
Definition
a rare condition in which there is an opening between the aorta and pulmonary trunk near the aortic valve (aorticopulmonary window defect)
Term
What is the most common cause of cyanotic heart disease in newborn infants? What comes with it?
Definition
transposition of the great arteries, there is also an ASD with or without an associated patent ductus arteriosus and a VSD - these permit some exchange between chambers
Term
What is the leading hypothesis for the formation of TGA? Why does this occur?
Definition
The conal growth hypothesis, failure of the conus arteriosus to develop normally during incorporation of the bulbus cordis into the ventricles, and then the aorticopulmonary septum fails to pursue a spiral course during partitioning
Term
What results with the division of the truncus arteriosus is so unequal that the pulmonary trunk has no lumen, or there is no orifice at the level of the pulmonary valve?
Definition
pulmonary atresia
Term
Pulmonary atresia with VSD is an extreme form of what defect condition?
Definition
Tetrology of Fallot
Term
What condition occurs when the left ventricle is small and nonfunctional, and the right ventricle maintains both pulmonary and systemic circulation?
Definition
Hypoplastic left heart syndrome
Term
In hypoplastic left heart syndrome, what abnormal shunts does blood pass through inside the heart? In addition to left sided underdevelopment, what else occurs?
Definition
ASD or dilated FO, atresia of the aortic or mitral orifice and hypoplasia of the ascending aorta
Term
How does the blood divert upon approaching the liver? What is the mechanism for adjusting it?
Definition
Half to ductus venosus --> IVC, half into sinusoids of the liver--> hepatic veins --> IVC, physiological sphincter prevents overloading of the heart when venous flow in the umbilical vein is high
Term
The inferior border of the septum secundum is called the...
Definition
crista dividens
Term
What happens to blood in the fetal lungs?
Definition
They extract oxygen from blood
Term
The arteries to which areas of the fetus receive well-oxygenated blood?
Definition
Head, heart, neck, upper limbs, liver
Term
What does the DA accomplish by shunting blood from the lungs?
Definition
Protects the lungs from circulatory overloading and allows right ventricle to strengthen in preparation for full functioning
Term
What happens to about 65% of the blood in the descending aorta?
Definition
Goes to umbilical arteries to return to placenta
Term
Aeration of the lungs at birth is associated with what 3 big changes in the lung vasculature?
Definition
Dramatic fall in pulmonary vascular resistance, marked increase in pulmonary blood flow, progressive thinning of the walls of pulmonary arteries
Term
Why does the foramen close at birth?
Definition
Increased pulmonary blood flow raises pressure in left atrium, closes valve of FO
Term
By the end of the first month, what are the relative sizes of the ventricles?
Definition
Left > right
Term
100% of DAs are functionally closed (except for PDA defects) at...
Definition
96 hours
Term
Closure of the DA appears to be mediated by ______, a substance released from the lungs during initial inflation. It has potent _____ effects on smooth muscle, and the action of it appears to be depending on _______ content of blood.
Definition
bradykinin, contractile, oxygen
Term
The effects of oxygen on the DA smooth muscle may be direct or mediated by its effects on _______ secretion. The anatomical close of the DA probably involves _______.
Definition
prostaglandin E2, TGF-B
Term
Inhibitors of prostaglandin synthesis, like _____, can cause constriction of a PDA in premature infants
Definition
indomethacin
Term
The umbilical vein eventually becomes what?
Definition
ligamentum teres
Term
The lumen of the _________ usually does not disappear completely, and may be cannulated even in some adults.
Definition
umbilical vein
Term
The ________ becomes the ligamentum venosum, however its close is more prolonged than the ___.
Definition
ductus venosus, DA
Term
Anatomical closure of the FO usually occurs by...
Definition
the 3rd month
Term
Functional closure of the DA is usually completed within...
Definition
the first few days after birth
Term
Anatomical closure of the ductus arteriosus and formation of the __________ normally occurs by...
Definition
ligamentum arteriosum, 12th week
Term
PDA is 2-3x more common in...
Definition
females
Term
PDA may result from failure of _____ induction after birth
Definition
TGF-B
Term
What is the most common congenital anomaly associated with maternal rubella infection during early pregnancy?
Definition
PDA
Term
Premature infants usually have what CHD?
Definition
PDA
Term
The lymphatic system begins to develop at the end of the...
Definition
6th week
Term
What are the 6 primary lymph sacs at the end of the embryonic period?
Definition
2 jugular, 2 iliac, 1 retroperitoneal, 1 cisterna chyli
Term
The thoracic duct develops from...
Definition
the caudal part of the right thoracic duct, the anastamosis between the thoracic ducts and the cranial part of the left thoracic duct
Term
What is derived from the cranial part of the right thoracic duct?
Definition
The right lymphatic duct
Term
The lymph sacs are transformed into groups of ________s during the early ______ period.
Definition
lymph nodes, fetal
Term
What cells invade the lymph sacs and break up the networks?
Definition
Mesenchymal cells
Term
The lymphocytes that appear in LNs before birth are derived from...
Definition
the thymus gland
Term
What develops from an aggregation of mesenchymal cells in the dorsal mesentery of the stomach?
Definition
Spleen
Term
What lymphatic structure develops from the second pair of pharyngeal pouches?
Definition
Palatine tonsils
Term
What develops from aggregations of lymph nodules around the openings of the Eustachain tubes? From aggregations in the wall of the nasopharynx? What about in the root of the tongue?
Definition
Tubal tonsils, pharyngeal tonsils, lingual tonsil
Term
What are two congenital anomalies of the lymphatic system?
Definition
congenital lymphedema and cystic hygroma
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