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Thorax Block
Embryo
44
Anatomy
Pre-School
10/27/2012

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Term
What are the five dilatation of the primitive heart tube and what do they form?
Definition
1. Truncus arteriosus - aorta & pulmonary trunk
2. Bulbus cordis - aortic vestibule & conus arteriosus
3. Primitive ventricle - trabeculated ventricle
4. Primitive atrium - trabeculated atrium
5. Sinus venosus - sinus venarum & coronary sinus
Term
About when does dextral looping of the heart occur?
Definition
-Day 26 to about 30/35
Term
What ridges form the AP septum?
Definition
-Truncal and bulbar ridges which are derived from neural crest cells.
Term
Persistant truncus arteriosus?
Definition
-AP septum doesn't form
-Causes marked cyanosis
Term
D-transposition of great arteries?
Definition
-AP septum doesn't spiral
-Systemic and pulmonary flow are completely separate
-Incompatible with life unless there is an accompanying shunt
Term
L-transposition of great arteries?
Definition
-No spiral of AP septum, but now the ventricles are reversed as well to compensate
Term
Tetralogy of Fallot?
Definition
-AV septum gets pushed towards pulmonary side
Causes;
1. Pulmonary stenosis (too small)
2. Overriding aorta (too big)
3. VSD (doesn't meed muscular septum)
4. Right Ventricular hypertrophy (bodies compensation for pulmonary stenosis; i.e. not a malformation)

-Results in R->L shunt and cyanosis
Term
Eisenmenger's syndrome?
Definition
-When L->R shunting eventually causes pulmonary hypertension and reversal to R->L (cyanotic) shunting
-Common in ASDs such as the primum and secundum types
Term
Secundum vs. primum type ASD
Definition
-Secundum ASD is from over-apoptosis of the septum primum to form the foramen secundum.
-Primum results from neural crest migration error (in endocardial cushion). Common in down syndrome
Term
What two cushions form the AV septum?
Definition
-Dorsal and Ventral AV cushions
Term
Persistent common AV canal?
Definition
-Dorsal and ventral AV cushions never fuse
-Causes there to be one big AV valve in the middle instead of the separate mitral and tricuspids.
-Results in L->R shunting and enlarged left atrium
Term
Ebstein's anomaly?
Definition
-Caused by malformation of posterior and septal cusps where they are displaced inferiorly
-Results from them not joining properly with the annulus fibrosus (part of cardiac skeleton)
-Results in a smaller right ventricle and pulmonary output
-Often associated with ASDs.
Term
Tricuspid atresia and associated problems?
Definition
-No tricuspid forms because of an AV septum defect and blood can't get to the right ventricle
-Accompanied by;
1. VSD
2. Patent foramen ovale
3. Overdeveloped left ventricle
4. Underdeveloped right ventricle
Term
What three structures form the membranous IV septum?
Definition
1. Right bulbar ridge
2. Left bulbar ridge (both part of the the AP septum)
3. AV cushions
Term
Membranous VSD?
Definition
- Initially causes L->R, but then Eisenmenger's complex takes place.
Term
Coronary arteries from from?
Definition
-Progenitor stem cells from the liver that become the peritruncal capillary ring and later the coronary aa.
Term
Double aortic arch?
Definition
-The right dorsal aorta doesn't regress so you end up with sort of two descending aorta that make a heart shape around the esophagus and trachea
-can cause problems in swallowing and breathing
Term
Patent ductus arteriosus implications, diagnosis and treatment?
Definition
-Causes L->R shunt
-Can hear a machine-like continuous murmur
-Can treat with indomethacin; a prostaglandin synthesis inhibitor
-Common in premees and mothers with rubella
Term
Postductal coarctation?
Definition
-Constriction of the aorta just distal to the ductus
-Causes an asymmetry of blood pressure
-Prostaglandin treatment won't really help in this case but may in preductal coarctation (less common)
Term
Aortic arches?
Definition
1. Maxillary
2. Stapedial
3. Common and internal carotids
4. R subclavian & L arch of aorta
5. (Regresses)
6. Pulmonary & ductus arteriosus
Term
What day for implantation?
Definition
Day 7
Term
What are the parts that make up the diaphragm and which is most susceptible to congenital hernias?
Definition
-Two pleuroperitoneal folds and a septum transversum (also some ingrowth from the body wall)
-The left fold closes last and is most susceptible to hernias
Term
How do you diagnose congenital diaphragmatic hernias, what do they cause, and where are they most common?
Definition
-Abdomen will be flat in supine position
-Will cause pulmonary hypoplasia
-Usually from left pleuroperitoneal fold error (i.e. left posterlateral side)
Term
Eventration of the diaphragm?
Definition
-Lack of muscular development allows viscera to push up into thorax, but not enter the cavity.
-Similar symptoms to CDHs
Term
Which AAs cant cross the placenta?
Definition
-The acidic ones (Glu & Asp)
-Neutral straight chains go slow but can get there (Ala & Gly)
Term
What happens overall with the placetal production of hormones?
Definition
-HCG is produced in high amounts from about week 4 to week 15 (maintains corpus luteum), and then progesterone and estrogen are produced (corpus luteum function replaced)
Term
Who's more acidic, fetus or mother?
Definition
-Mother; lowers O2 affinity in mother.
Term
Velamentous cord insertion
Definition
-When the umbilical cord inserts into the membrane instead of the baby leaving the vessels vulnerable to rupture
Term
Battledore placenta?
Definition
- When the umbilical cord attaches at the margin of the placenta
-Asymptomatic and rare
Term
Placenta accreta?
Definition
-Abnormally deep attachment into myometrium of the uterus
-When it's really deep it's called placenta percreta?
Term
Placenta previa?
Definition
-Low implantation leading to vascularization complications.
Term
Placental abruption and common cause?
Definition
-Premature separation of placenta from uterine wall
-Fairly common and kills the fetus about a third of the time
-More common with hypertensive mothers
Term
When does twinning give siamese twins?
What about other twinning?
Definition
-If it occurs around week 2
-Day 9 twinning will result in only one amnion
-Day 4 will give two amnion
-Earlier will give two amnions and chorions
Term
Tracheoesophageal fistulas and esophageal atresia; most common arrangement, and what is the basis?
Definition
-Joint atresia and fistula (inferior) is most common.
-Caused because the trachea-esophageal septum doesn't form correctly; usually because the folds don't meet
Term
Lung branching mechanism?
Definition
-Shh produced at apex of growing bud (endoderm) inhibits FGF10 action (produced in overlying splanchnic mesoderm) induces bifurcation
Term
Surfactant production, stimulation, and timing?
Definition
-It is produced by Type II pneumocytes
-Growth of these cells can be stimulated by corticosteroid treatment of mother or baby
-Can also use thyroxine
-Surfactant is normally produced in high amounts during the last two weeks of gestation (this is the main reason for INFANT RESPIRATORY DISTRESS SYNDROME in premees)
Term
Type I vs type II pneumocytes?
Definition
-Type I are squamous epithelial
-Type II are cuboidal and produce surfactant
Term
Congenital Cystic Adenomatoid
Definition
-Fluid filled mass of abnormal lung tissue from pulmonary malformation
-Usually resolves on its own but is fatal 10% of the time
Term
Meconium aspiration syndrome?
Definition
-Meconium is fetal feces that can get in lungs if inhaled and cause issues
-Risks are hypertension, smoking, low amniotic fluid
Term
Ectopia cordis?
Definition
-Heart is on outside
Term
Dextrocardia?
Definition
-Tip of heart points to right.
-From improper folding
Term
HLHS?
Definition
-Hypoplastic left heart syndrome
-Mostly missing the left ventricle
Term
Gastroschisis
Definition
-abdominal wall defect where organs are outside
Term
Hyaline membrane disease
Definition
-Another name for infant respiratory distress syndrome.
-Usually from no surfactant from type II pneumocytes
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