Cardiovascular System

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GENERAL

• 1st functional organ system in the embryo
• Cardiac pathology during development is either genetic, enviornmental or combination of both
• Cardiac structures arise initially from mesoderm which proliferates into angiogenic cell clusters. These intraembryonic clusters multiply and coalese to form a plexus with a lumen (= the embryonic cardiac tube)
• The extraembryonic cell clusters form the vitelline & umbilical vesels which by budding contact the heart tube

DEVELOPMENT OF THE HEART

(Fig. 1)

• Mechamisms that initiate formation of the heart are not well understood; however the heart tube position is initially determined by brain growth
• Formation of the neural tube by folding causes fusion of the heart tube in the midline, to become a single endocardial tube
• The primitive heart tube buldges into the pericardial cavity where it is surrounded by splanchnopluric meso-derm. Resulting heart tube consists of 4 layers: the endocardium, the cardiac jelly (= endocardial cushions) the myocardium, and the epicardium
• At this stage embryo is 23 days old and the heart begins to beat from a focus in the sinus venosus

FORMATION OF THE HEART LOOP

(Fig. 2)

1. Intrapericardial = bulboventricular portion of heart
2. Extrapericardial = atrium/sinus venous + Ao roots

• During the next stage of development, the bulboventricular portion of the heart forms a loop to the RIGHT, forming a flange (= the bulboventircular flange)
• Region proximal to flange expands to become the embryonic ventricles, while the distal portion becomes the bulbus cordis
• Mechanism of cardiac looping not well understood

Relevant Article Depot:

Test Your Knowledge:increase in mean airway pressure effect on complex cardiac anatomy

Test Your Knowledge:post-op cardiac hemodynamics

Reference Values for Noninvasive Blood Pressure in Children during Anesthesia: A Multicentered Retrospective Observational Cohort Study

Preoperative Fluid Fasting Times and Postinduction Low Blood Pressure in Children: A Retrospective Analysis