09 Vasculature 2024 Student

EMBRYOLOGY
Lecture 9:
Development of the Vasculature
Theme: start with symmetry, then shift it
Kulesza
Readings:
Chapter 13 [pages 185-200]
DEVELOPMENT OF THE ARTERIES
All arteries, veins and lymphatic channels develop from mesoderm
All vessels begin as groups of mesodermal cell clusters.
Extraembryonic vessels form initially from the yolk sac.

Embryonic vessels form shortly after the extraembryonic vessels.
RBC cells form from:

1. the yolk sac
2. liver
3. spleen, thymus &
bone marrow
BIG THREE ARTERIAL NETWORKS
1. Aortic Arches: associated with pharyngeal arches (4th and 5th weeks)
2. Vitelline
3. Umbilical
3
1
2
AORTIC ARCHES, PT 1 (SYMMETRY)
Heart
Truncus arteriosus
AORTIC ARCHES, PT 2 (START SHIFTING)
AORTIC ARCHES, PT 3 (ASYMMETRY)
RIGHT LEFT
Arch IV/4 Subclavian Arch of aorta
Arch VI/6 Right pulmonary artery Left pulm. Artery & ductus arte
Dorsal aorta (Nothing) Aorta
Right vagus nerve innervates

Laryngopharynx and SA node
DUCTUS ARTERIOSUS BECOMES LIGAMENTUM
ARTERIOSUS…USUALLY
Ligamentum arteriosus is the
remnant of ductus arteriosus
DUCTUS ARTERIOSUS BECOMES LIGAMENTUM
ARTERIOSUS…USUALLY
 Patent Ductus Arteriosus (PDS): 1:2500-5000; 30x higher incidence at high altitudes
 continuous murmur head best at L sternal border
 Permits flow from aorta into PA; recirculation through lungs = L overload and
enlargement
Physical examination of a 15-month-old
male reveals a continuous machinery-
sounding murmur. The murmur is heard
best in the region indicated by the
stethoscope on the accompanying figure.
An echocardiogram reveals blood flow
between the aorta and pulmonary trunk.
1. What is the most likely diagnosis?

PDA
2. What aortic arch is involved? Left
6th aortic arch
3. What nerve is most in danger of
iatrogenic injury during surgical
repair?
Left recurrent laryngeal nerve
COARCTATION (NARROWING) OF THE AORTA
 In 95% of cases the narrowing is
immediately distal to L
subclavian artery
 50-85% of cases are complicated
by a bicuspid aortic valve
 Key S/S: BP – UL > LL, delayed
femoral pulses, continuous
systolic murmur heard over L
scapula (blood flow through the
coarctation); adults: rib notching
on chest radiographs
Student Dr. ?
COARCTATION OF THE AORTA
1. FIGURE 3 SIGN
2. RIB NOTCHING
COARCTATION OF THE AORTA
1. FIGURE 3 SIGN
Squiggly (Tortuous) vessels
2. RIB NOTCHING
These tortuous vessels form the

characteristic rib notches. Patients Subclavian a.
only come in with this condition
later in life. Doesn’t have to be a
newborn.
Enlarged intercostal ve
Imaging from a 25-year-old female with
hypertension.
What is the diagnosis?
coarctation
3D (posterior view)
Student Dr
MMS:
Angiogram from a
27-year-old male
b with dysphagia,
c
reveals:
e
a d What is the
diagnosis?
VITELLINE ARTERIES
Celiac (for
Superior mese
Inferior mesenter
OTHER BRANCHES FROM THE AORTA
• intercostal
• middle suprarenal
• renal
• “gonadal”
WHAT IS AN ARTERY?
WHAT IS A VEIN?
UMBILICAL
ARTERIES
VENOUS SYSTEM
During the 5th week of development, three SYMMETRIC systems of veins can be observed:
1. vitelline (omphalomesenteric)  gut/yolk sac
2. umbilical
3. cardinal
SHIFTING VITELLINE AND
UMBILICAL VEINS
Right Left
Keep Ditch. Vitelline
Ditch Keep Umbilical
Shift Shift Cardinal
Left umbilical vein

UMBILICAL VEINS
• the ductus venosus bypasses the
sinusoids of the liver
• after birth the left umbilical vein

obliterates to form the
ligamentum teres hepatis
• after birth the ductus venosum

obliterates to form the
ligamentum venosum
CARDINAL VEINS 1. “cardinal”
2. Symmetry  Right
**START WITH SYMMETRY, THEN  SVC, azygos, IVC
SHIFT** 3. Testicular/Ovarian v
4. Clinical Note: Big veins can be
doubled or on the wrong side
Gonadal vessels
DOUBLE SUPERIOR VENA CAVA
Think/Pair/Share
During fetal life, in which of the
following structures is the percent
hemoglobin/oxygen saturation level
of fetal blood the highest?
A. Aortic arch
B. Pulmonary vein
C. Inferior vena cava
D. Ductus arteriosus
E. Portal vein
F. Umbilical artery
What is the function of the:
1. Valve of the coronary sinus
Draining from heart muscle
into right atria
(valves are there to
prevent backflow)
2. Valve of the IVC
Blood from IVC goes to
foramen ovale
NEONATAL CIRCULATION
FETAL VASCULAR SHUNTS & REMNANTS
Fetal Structure Shunt Adult Remnant
Umbilical vein Placenta  liver + ductus venosusLigamentum teres hepatis/Round lig of

liver
Ductus venosus Umbilical vein  IVC Ligamentum venosum
Foramen ovale R atrium  L atrium Fossa ovale, valve of

foramen ovale
Ductus arteriosus Pulmonary a  aorta Ligamentum arteriosum
Umbilical artery Common iliac artery  placenta Superior vesical arteries; medial umbilical lig
LYMPHATIC SYSTEM: SYMMETRY THEN SHIFT IT
LYMPHATIC SYSTEM:
ANOMALIES
Cystic hygroma
Congenital Lymphedema
fluid filled
Cystic hygroma

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EMBRYOLOGY

Extraembryonic vessels form initially from the yolk sac.

RBC cells form from:

Right vagus nerve innervates

1. What is the most likely diagnosis?

These tortuous vessels form the

What is the diagnosis?

Left umbilical vein

• after birth the left umbilical vein

• after birth the ductus venosum

Fetal Structure Shunt Adult Remnant

Umbilical vein Placenta  liver + ductus venosusLigamentum teres hepatis/Round lig of

Ductus venosus Umbilical vein  IVC Ligamentum venosum

Foramen ovale R atrium  L atrium Fossa ovale, valve of

Ductus arteriosus Pulmonary a  aorta Ligamentum arteriosum

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