<p>The Cardiovascular System (Part II)</p><p>黃敏銓 [email protected] 解剖學暨細胞生物學研究所 1 Development of <a href="/tags/Vein/" rel="tag">veins</a></p><p>Three paired veins drain into the tubular <a href="/tags/Heart/" rel="tag">heart</a> of a 4-week <a href="/tags/Embryo/" rel="tag">embryo</a></p><p>• Vitelline veins: poorly oxygenated <a href="/tags/Blood/" rel="tag">blood</a> from <a href="/tags/Yolk/" rel="tag">yolk</a> sac • Umbilical veins: oxygenated blood from the primordial <a href="/tags/Placenta/" rel="tag">placenta</a> • <a href="/tags/Common_cardinal_veins/" rel="tag">Common cardinal veins</a>: poorly oxygenated blood from the body of the embryo</p><p>2 Three paired veins Cardinal veins 26 days <a href="/tags/Sinus_venosus/" rel="tag">Sinus venosus</a> <a href="/tags/Pharyngeal_arch/" rel="tag">Pharyngeal arch</a> <a href="/tags/Artery/" rel="tag">arteries</a></p><p>Blue color</p><p>Vitelline <a href="/tags/Vein/" rel="tag">vein</a> <a href="/tags/Umbilical_vein/" rel="tag">Umbilical vein</a> Umbilical vesicle (well-oxygenated)</p><p>3 Three paired veins enter into the sinus venosus</p><p>Left Right Dorsal view 24 days</p><p>4 Vitelline veins IVC, Hepatic veins & sinusoids, and portal vein</p><p>Left Right</p><p>Hepatic segment of IVC: right vitelline vein Hepatic veins: vitelline veins</p><p>Hepatic sinusoids <a href="/tags/Liver/" rel="tag">Liver</a></p><p>Portal vein: vitelline veins</p><p>Dorsal view (7 weeks) Duodenum 5 Umbilical veins Umbilical vein : left umbilical vein</p><p>Left Right</p><p>7th week</p><p>(Ligamentum venosum)</p><p>Dorsal view 6 Anterior cardinal veins Brachiocephalic veins 7 weeks Anastomosis between anterior cardinal veins</p><p>Left Right</p><p>8 weeks Left brachiocephalic vein Right brachiocephalic vein</p><p>Dorsal view 7 <a href="/tags/Superior_vena_cava/" rel="tag">Superior vena cava</a></p><p>(Oblique vein of left atrium)</p><p>Indian Pacing Electrophysiol. J.</p><p>Superior vena cava</p><p>Left Right <a href="/tags/Anterior_cardinal_vein/" rel="tag">anterior cardinal vein</a> Right common cardinal vein Right</p><p>(Left horn of sinus venosus) 8 Dorsal view Left brachiocephalic vein Left superior intercostal vein</p><p>Oblique vein to coronary sinus Posterior cardinal veins: root of azygos v. and common iliac veins</p><p>6 weeks Adult</p><p>Azygos v. <a href="/tags/Posterior_cardinal_vein/" rel="tag">Posterior cardinal vein</a> (mesonephroi)</p><p>Common iliac veins</p><p>10 Right Left Subcardinal veins and supracardinal veins replace and supplement posterior cardinal veins</p><p>Supracardinal v.</p><p>Posterior cardinal v. Subcardinal v.</p><p>Right Left</p><p>6 weeks 7 weeks 11 Subcardinal veins</p><p>IVC (prerenal seg.) Stem of L. renal v.</p><p>R. suprarenal v. L. suprarenal v.</p><p>Subcardinal vein R. gonadal v. L. gonadal v.</p><p>6 weeks Adult 12 Right Left Supracardinal veins</p><p>Azygos v. Hemiazygos v.</p><p>IVC (postrenal seg.) degeneration</p><p>8 weeks Right Adult Left</p><p>Supracardinal vein 13 Inferior vena cava (IVC)</p><p>Left Right</p><p>IVC (hepatic segment): R. vitelline vein</p><p>IVC (prerenal segment): R. subcardinal v.</p><p>IVC (renal segment): Subcardinal-supracardinal anastomosis</p><p>IVC (postrenal segment): R. supracardinal v.</p><p>14 Right Adult Left The primordial pulmonary vein develops in the dorsal wall of the left atrium Development of arteries</p><p> Pharyngeal arch arteries  Dorsal <a href="/tags/Aorta/" rel="tag">aorta</a>  Intersegmental arteries  <a href="/tags/Vitelline_arteries/" rel="tag">Vitelline arteries</a>  Umbilical arteries</p><p>16 Intersegmental arteries Pharyngeal arch arteries <a href="/tags/Dorsal_aorta/" rel="tag">Dorsal aorta</a> (<a href="/tags/Aortic_arches/" rel="tag">Aortic arches</a>) Umbilical <a href="/tags/Artery/" rel="tag">artery</a></p><p>Pharyngeal arches</p><p>Aortic sac</p><p>4th-5th week (26 days) Vielline artery</p><p>17 Intersegmental arteries</p><p>• 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.</p><p>18 Vitelline arteries • Celiac trunk: foregut • Superior mesenteric artery: midgut • Inferior mesenteric artery: hindgut</p><p>19 Umbilical arteries</p><p>• Proximal parts – <a href="/tags/Umbilical_artery/" rel="tag">Umbilical artery</a> (branch of Internal iliac arteries) – Superior vesical arteries • Distal parts – Medial umbilical <a href="/tags/Ligament/" rel="tag">ligaments</a></p><p>20 Derivatives of pharyngeal arch arteries</p><p>Pharyngeal arch arteries (Aortic arches)</p><p>21 Pharyngeal arches and pharyngeal arch arteries Pharyngeal arch arteries</p><p>26 days</p><p>22 Primordial pharyngeal arch arterial pattern is transformed into the final fetal arterial arrangement during the 8th week</p><p>(1st, 2nd pairs disappeared) 3rd, 4th, and 6th pharyngeal arch arteries</p><p>6 weeks 8 weeks 23 Derivatives of the 1st pair pharyngeal arch arteries</p><p>• Maxillary arteries – Ears, teeth, muscles of eyes and face • External carotid arteries Pharyngeal arch arteries</p><p>1st pair of pharyngeal arch arteries</p><p>24 Derivatives of the 2nd pair pharyngeal arch arteries Stems of the stapedial arteries</p><p>Stapedial artery: 第10週退化 Persistent stapedial artery: 異常</p><p>Pharyngeal arch arteries</p><p>2nd pair of pharyngeal arch arteries (dorsal part)</p><p>25 Derivatives of the 3rd pair pharyngeal arch arteries</p><p>6 weeks 7 weeks</p><p>Internal carotid artery</p><p>Common carotid artery</p><p>Pharyngeal arch arteries</p><p>26 Derivatives of the 4th pair pharyngeal arch arteries</p><p>1. Right: proximal part of right <a href="/tags/Subclavian_artery/" rel="tag">subclavian artery</a> 2. Left: part of arch of aorta</p><p>1 1 Right subclavian artery 2 Left subclavian artery 2</p><p>Right dorsal aorta</p><p>7th intersegmental arteries</p><p> right left 27 Fate of 5th pair of pharyngeal arch arteries </p><p>• 50% <a href="/tags/Embryo/" rel="tag">embryos</a>: rudimentary vessels – no vascular derivatives</p><p>• 50% embryos: no 5th pair arteries develop</p><p>28 Derivatives of the 6th pair pharyngeal arch arteries</p><p>Right: Proximal: right <a href="/tags/Pulmonary_artery/" rel="tag">pulmonary artery</a> (proximal) Distal: degeneration</p><p>Left: Proximal: left pulmonary artery (proximal) Distal: <a href="/tags/Ductus_arteriosus/" rel="tag">ductus arteriosus</a></p><p>29 Left recurrent laryngeal <a href="/tags/Nerve/" rel="tag">nerve</a> hooks around the ligamentum arteriosum and aortic arch </p><p>30 Why the course of the recurrent laryngeal <a href="/tags/Nerve/" rel="tag">nerves</a> differs? Pharyngeal arch arteries</p><p>6 weeks</p><p> ductus arteriosus</p><p>Child 31 8 weeks right left Right and left subclavian artery Arch of aorta</p><p>1 1 Right subclavian artery 2 Left subclavian artery 2</p><p>Right dorsal aorta</p><p>7th intersegmental arteries</p><p> right left right left</p><p>32 Aortic Arch Anomalies</p><p>• Coarctation of Aorta: 10% of CHD</p><p>• Double Aortic Arch</p><p>• Right Arch of Aorta</p><p>• Anomalous Right Subclavian Artery</p><p>33 Coarctation of Aorta</p><p>Male : Female≒2:1 70% cases : bicuspid aortic valve • Juxtaductal coarctation: 90% • Postductal coarctation • Preductal coarctation</p><p>Preductal coarctation</p><p>Postductal coarctation</p><p>Ductus arteriosus Ductus arteriosus 34 Collateral circulation during the fetal period in postductal coarctation</p><p>35 Preductal coarctation</p><p>Ductus arteriosus</p><p>Closure of DA in infant results in hypoperfusion and rapid deterioration</p><p>Treatment: infusion of <a href="/tags/Prostaglandin/" rel="tag">prostaglandin</a> E2 to re-open the ductus arteriosus</p><p>36 Double Aortic Arch Vascular ring around the <a href="/tags/Trachea/" rel="tag">trachea</a> and <a href="/tags/Esophagus/" rel="tag">esophagus</a></p><p>Large right arch of aorta</p><p>Small left arch of aorta</p><p>Normally involutes</p><p>37 Right arch of aorta</p><p>Area of abnormal involution</p><p>Retroesophageal right arch of aorta</p><p>Right arch of aorta</p><p>38 Anomalous Right Subclavian Artery</p><p>Abnormal involution Persistent portion of right dorsal aorta</p><p>Right subclavian artery</p><p>Right subclavian artery</p><p>39 Six primary <a href="/tags/Lymph_sacs/" rel="tag">lymph sacs</a> at the end of embryonic period</p><p>Begins to develop at the end of the 6th week</p><p>(2) Head, neck, upper limbs Cystic hygroma</p><p>(1) Primordial gut (1)</p><p>(2)</p><p>Lower trunk, lower limbs 40 7.5-week embryo 9-week embryo Right lymphatic duct</p><p>Right and left thoracic ducts</p><p>Thoracic duct Right Left Chyle cistern (cisterna chyli)</p><p>41 </p>