The Cardiovascular System (Part II)

Transcription

1 The Cardiovascular System (Part II) 黃敏銓 解剖學暨細胞生物學研究所 1

2 Development of veins Three paired veins drain into the tubular heart of a 4-week embryo Vitelline veins: poorly oxygenated blood from yolk sac Umbilical veins: oxygenated blood from the primordial placenta Common cardinal veins: poorly oxygenated blood from the body of the embryo 2

3 Three paired veins Sinus venosus Pharyngeal arch arteries Cardinal veins 26 days Blue color Vitelline vein Umbilical vesicle Umbilical vein (well-oxygenated) 3

4 Three paired veins enter into the sinus venosus Left Right Dorsal view 24 days 4

5 Vitelline veins IVC, Hepatic veins & sinusoids, and portal vein Left Right Hepatic segment of IVC: right vitelline vein Hepatic veins: vitelline veins Hepatic sinusoids Liver Portal vein: vitelline veins Dorsal view (7 weeks) Duodenum 5

6 Umbilical veins Umbilical vein : left umbilical vein Left Right 7th week (Ligamentum venosum) Dorsal view 6

7 7 weeks Anterior cardinal veins Brachiocephalic veins Anastomosis between anterior cardinal veins Left Right 8 weeks Left brachiocephalic vein Right brachiocephalic vein Dorsal view 7

8 Superior vena cava (Oblique vein of left atrium) Indian Pacing Electrophysiol. J. Left Right Superior vena cava Right anterior cardinal vein Right common cardinal vein (Left horn of sinus venosus) Dorsal view 8

9 Left brachiocephalic vein Left superior intercostal vein Oblique vein to coronary sinus

10 Posterior cardinal veins: root of azygos v. and common iliac veins 6 weeks Adult Azygos v. Posterior cardinal vein (mesonephroi) Common iliac veins Right Left 10

11 Subcardinal veins and supracardinal veins replace and supplement posterior cardinal veins Posterior cardinal v. Supracardinal v. Subcardinal v. Right Left 6 weeks 7 weeks 11

12 Subcardinal veins IVC (prerenal seg.) R. suprarenal v. Stem of L. renal v. L. suprarenal v. Subcardinal vein R. gonadal v. L. gonadal v. 6 weeks Right Adult Left 12

13 Supracardinal veins Azygos v. Hemiazygos v. IVC (postrenal seg.) degeneration 8 weeks Right Adult Left Supracardinal vein 13

14 Inferior vena cava (IVC) Left Right IVC (prerenal segment): R. subcardinal v. IVC (renal segment): Subcardinal-supracardinal anastomosis IVC (hepatic segment): R. vitelline vein IVC (postrenal segment): R. supracardinal v. Right Adult Left 14

15 The primordial pulmonary vein develops in the dorsal wall of the left atrium

16 Development of arteries Pharyngeal arch arteries Dorsal aorta Intersegmental arteries Vitelline arteries Umbilical arteries 16

17 Pharyngeal arch arteries (Aortic arches) Intersegmental arteries Dorsal aorta Umbilical artery Pharyngeal arches Aortic sac 4th-5th week (26 days) Vielline artery 17

18 Intersegmental arteries Neck: vertebral arteries Thorax: intercostal arteries Abdomen: lumbar arteries 5th pair: common iliac arteries Sacrum: lateral sacral arteries Caudal end of dorsal aorta: median sacral artery. 18

19 Vitelline arteries Celiac trunk: foregut Superior mesenteric artery: midgut Inferior mesenteric artery: hindgut 19

20 Umbilical arteries Proximal parts Umbilical artery (branch of Internal iliac arteries) Superior vesical arteries Distal parts Medial umbilical ligaments 20

21 Derivatives of pharyngeal arch arteries Pharyngeal arch arteries (Aortic arches) 21

22 Pharyngeal arches and pharyngeal arch arteries Pharyngeal arch arteries 26 days 22

23 Primordial pharyngeal arch arterial pattern is transformed into the final fetal arterial arrangement during the 8 th week (1st, 2nd pairs disappeared) 3 rd, 4 th, and 6 th pharyngeal arch arteries 6 weeks 8 weeks 23

24 Derivatives of the 1st pair pharyngeal arch arteries Maxillary arteries Ears, teeth, muscles of eyes and face External carotid arteries Pharyngeal arch arteries 1st pair of pharyngeal arch arteries 24

25 Derivatives of the 2nd pair pharyngeal arch arteries Stems of the stapedial arteries Stapedial artery: 第 10 週退化 Persistent stapedial artery: 異常 Pharyngeal arch arteries 2nd pair of pharyngeal arch arteries (dorsal part) 25

26 Derivatives of the 3rd pair pharyngeal arch arteries 6 weeks 7 weeks Pharyngeal arch arteries Internal carotid artery Common carotid artery 26

27 Derivatives of the 4th pair pharyngeal arch arteries 1. Right: proximal part of right subclavian artery 2. Left: part of arch of aorta 1 2 Right subclavian artery 1 2 Left subclavian artery Right dorsal aorta 7th intersegmental arteries right left 27

28 Fate of 5th pair of pharyngeal arch arteries 50% embryos: rudimentary vessels no vascular derivatives 50% embryos: no 5th pair arteries develop 28

29 Derivatives of the 6th pair pharyngeal arch arteries Right: Proximal: right pulmonary artery (proximal) Distal: degeneration Left: Proximal: left pulmonary artery (proximal) Distal: ductus arteriosus 29

30 Left recurrent laryngeal nerve hooks around the ligamentum arteriosum and aortic arch 30

31 Why the course of the recurrent laryngeal nerves differs? Pharyngeal arch arteries 6 weeks ductus arteriosus 8 weeks right left Child 31

32 Right and left subclavian artery Arch of aorta Right subclavian artery 2 Left subclavian artery Right dorsal aorta 7th intersegmental arteries right left right left 32

33 Aortic Arch Anomalies Coarctation of Aorta: 10% of CHD Double Aortic Arch Right Arch of Aorta Anomalous Right Subclavian Artery 33

34 Coarctation of Aorta Male : Female 2:1 70% cases : bicuspid aortic valve Juxtaductal coarctation: 90% Postductal coarctation Preductal coarctation Preductal coarctation Postductal coarctation Ductus arteriosus Ductus arteriosus 34

35 Collateral circulation during the fetal period in postductal coarctation 35

36 Preductal coarctation Ductus arteriosus Closure of DA in infant results in hypoperfusion and rapid deterioration Treatment: infusion of prostaglandin E 2 to re-open the ductus arteriosus 36

37 Double Aortic Arch Vascular ring around the trachea and esophagus Large right arch of aorta Small left arch of aorta Normally involutes 37

38 Right arch of aorta Area of abnormal involution Retroesophageal right arch of aorta Right arch of aorta 38

39 Anomalous Right Subclavian Artery Abnormal involution Persistent portion of right dorsal aorta Right subclavian artery Right subclavian artery 39

40 Six primary lymph sacs at the end of embryonic period Begins to develop at the end of the 6th week Head, neck, upper limbs (1) Primordial gut (1) (2) Cystic hygroma 7.5-week embryo (2) Lower trunk, lower limbs 40

41 9-week embryo Right lymphatic duct Right and left thoracic ducts Right Thoracic duct Chyle cistern (cisterna chyli) Left 41

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