pediagenosis
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Monday, August 18, 2025

Formation of the Heart Tube

Formation of the Heart Tube

Formation of the Heart Tube

Formation of the Heart Tube



ONE-SOMITE AND TWO-SOMITE STAGES

As the primitive, bilaterally symmetric cardiovascular system appears, shaping of the embryo during the fourth week profoundly influences the relative position of the cardiac portion of this system. The trilaminar embryonic disc folds into a cylinder, and the amnion tucks around the embryo on each side. The amnion also envelops the head end of the embryo as the ectodermal tube of the forebrain rapidly increases in size in a cranial and ventral direction. The result is a 180-degree sagittal plane rotation of the cardiogenic mesoderm and oropharyngeal membrane, which were originally cranial to the neural plate and the developing neural tube. The heart is now caudal to the oropharyngeal membrane rather than cranial, and the heart locates dorsal to the developing pericardial cavity (see Plate 4-3).

Early Intraembryonic Vasculogenesis

Early Intraembryonic Vasculogenesis

Early Intraembryonic Vasculogenesis

Presomite stage (1.5-mm embryo) at approximately 20 days
Presomite stage (1.5-mm embryo) at approximately 20 days



PRESOMITE STAGE

Although not the first organ system to make its appearance in the embryo, the cardiovascular system reaches a functional state long before the other systems, and doing so while still in a relatively primitive state of development. The vascular system grows from a simple, bilaterally symmetric plexus into an asymmetric, complex system of arteries, veins, and capillaries a necessarily dynamic process involving the formation of new vessels and temporary detours, rerouting of the bloodstream, and the disappearance of previously dominant channels or even of entire vascular subsystems. The vascular system needs to enlarge as the embryo grows, adapting to marked changes in embryonic shape and developmental changes in other organ systems. While hard at work, the heart also must grow and differentiate from a simple tube into a complex, four-chambered organ with sets of valves. Finally, because the very young embryo is tiny compared to the mass of extraembryonic (placental) tissue, which the young heart also supplies with blood, this heart is relatively enormous compared with its relative size in the adult. Describing the development of the cardiovascular system first requires review of the intraembryonic coelom (“body cavity”) formed by the confluence of small, initially isolated spaces that appear in the lateral mesoderm and cardiogenic mesoderm. The spaces fuse together and form the single, horseshoe-shaped intraembryonic coelom that extends the length of the embryo in the lateral mesoderm on each side, communicating across the midline cranially in the cardiogenic mesoderm. Later in development, a communication develops on each side between the caudal ends of the intraembryonic coelom and the extraembryonic coelom. The formation of the coelom separates the lateral mesoderm into two layers: the parietal layer in contact with the ectoderm and the visceral layer in contact with the endoderm. The ectoderm with its parietal layer of lateral plate mesoderm is called somatopleure; endoderm with its visceral mesodermal layer is called splanchnopleure.

EARLY EMBRYONIC DEVELOPMENT

EARLY EMBRYONIC DEVELOPMENT

EARLY EMBRYONIC DEVELOPMENT

EARLY EMBRYONIC DEVELOPMENT



In humans, as in most other primates, fertilization takes place in the distal part of the uterine tube, near its fimbriated end, about 12 to 24 hours after ovulation. The fertilized ovum, or zygote, is transported to the uterus by rhythmic contractions of the tube, aided by the action of the cilia of the epithelium. During this passage down the uterine tube, which takes about 4 days, the zygote executes a number of cell divisions and, on reaching the uterus, consists of a clump of blastomeres, the morula, which has not increased appreciably in size from the zygote.

Sunday, August 17, 2025

CARDIAC MAGNETIC RESONANCE IMAGING

CARDIAC MAGNETIC RESONANCE IMAGING

CARDIAC MAGNETIC RESONANCE IMAGING

CARDIAC MAGNETIC RESONANCE IMAGING



Cardiac magnetic resonance imaging (MRI) does not use radiation and is based on fundamental principles related to the presence of water in all tissues. Since two protons are contained in a water molecule, when put in a magnetic field, they can be aligned. If the magnetic field is turned off, the photons can return to their original position and generate a radio signal that can be detected and quantitated for an image. The images obtained can help assess ventricular function, aortic disease, ischemic heart disease, cardiomyopathies, pericardial disease, valvular heart disease, cardiac masses, congenital heart disease, pulmonary vascular disease, and coronary artery bypass grafting. In the near future, electrophysiologists will be using cardiac MRI to evaluate atrial morphology before atrial fibrillation ablation therapy (see Plates 3-20 and 3-21).

COMPUTED TOMOGRAPHIC ANGIOGRAPHY

COMPUTED TOMOGRAPHIC ANGIOGRAPHY

COMPUTED TOMOGRAPHIC ANGIOGRAPHY

COMPUTED TOMOGRAPHIC ANGIOGRAPHY



Computed tomographic angiography (CTA) is a 3D image reconstructed from multiple slices of tomographic images of a particular body part (e.g., brain, chest, blood vessels, abdomen, pelvis, joints). CTA of the heart includes the coronary arteries. Because CT studies are created by computer processing, the images can be seen in multiple planes, and ventricles, atria, veins, and arteries can be easily delineated. Pulmonary CTA can reveal emboli in both right and left pulmonary arteries and some subdivisions, as well as in the main pulmonary artery (see Plate 3-19).

VENTRICULOGRAPHY

VENTRICULOGRAPHY

VENTRICULOGRAPHY

MEASUREMENT OF LEFT VENTRICULAR FUNCTION USING VENTRICULOGRAPHY
MEASUREMENT OF LEFT VENTRICULAR FUNCTION USING VENTRICULOGRAPHY



In ventriculography a catheter (usually pigtail) is introduced into the ventricle and radiopaque contrast material injected (see Plate 3-17). The ventricle is then visualized by fluoroscopy/cine as it contracts and relaxes, to assess ventricular wall motion and calculate ejection fraction (EF; normal 55%). Ejection fraction is calculated by the formula EF = SV/EDV, where SV is stroke volume and EDV end-diastolic volume.

Myocardial Perfusion Imaging

Myocardial Perfusion Imaging

Myocardial Perfusion Imaging

Myocardial Perfusion Imaging



Use of myocardial perfusion imaging (MPI or MPS) is preferable to “stress nuclear imaging,” but both terms are used interchangeably. In general, images at peak stress and at rest reflect changes in the distribution of the radiopharmaceutical if ischemia is present (see Plate 3-16; SPECT, single-photon emission tomography). Indications for MPI are as follows :

EXERCISE AND CONTRAST ECHOCARDIOGRAPHY

EXERCISE AND CONTRAST ECHOCARDIOGRAPHY

EXERCISE AND CONTRAST ECHOCARDIOGRAPHY

EXERCISE AND CONTRAST ECHOCARDIOGRAPHY



EXERCISE ECHOCARDIOGRAPHY

This type of stress test generally involves walking on a treadmill after a baseline echocardiogram is obtained (see Plate 3-15). During treadmill exercise the heart rate increases, and if myocardial ischemia occurs, wall motion abnormalities can be detected, which return to baseline at rest or after nitroglycerin. This is highly suggestive of a high-grade stenosis of a coronary artery; identification of the specific artery depends on the distribution of the wall motion abnormality. For example, if the ventricular septum contracts normally at rest but with exercise barely moves, this suggests disease in the anterior descending coronary artery. In contrast, a similar situation with the inferior wall suggests disease of the vessel supplying the posterior descending coronary artery.

TRANSESOPHAGEAL ECHOCARDIOGRAPHY

TRANSESOPHAGEAL ECHOCARDIOGRAPHY

TRANSESOPHAGEAL ECHOCARDIOGRAPHY

TRANSESOPHAGEAL ECHOCARDIOGRAPHY


Transesophageal echocardiography (TEE) requires an ultrasound transducer at the tip of a probe that can be passed into the patient’s esophagus, which lies directly behind the left atrium, as well as into the gastric area (see Plate 3-14). Sedation is required, and TEE should be performed only by a certified physician (e.g., cardiologist, cardiac anesthesiologist), not echo technologists. TEE does not replace transthoracic echocardiography but does provide clearer images, especially images that are more difficult to view with transthoracic US, such as the left atrial appendage. This feature is extremely important before cardioversion of patients in atrial fibrillation with uncertain onset. If the atrial appendage is free of clots, the patient is considered at very low risk for emboli to the brain.

Friday, May 30, 2025

DOPPLER ECHOCARDIOGRAPHY

DOPPLER ECHOCARDIOGRAPHY

DOPPLER ECHOCARDIOGRAPHY

PRINCIPLES OF DOPPLER ECHOCARDIOGRAPHY
Plate 3-13
PRINCIPLES OF DOPPLER ECHOCARDIOGRAPHY


Echocardiography with Doppler ultrasound is based on the principle of estimating velocity and direction of blood flow by using moving red blood cells as a target (see Plate 3-13). There are two types of Doppler US: continuous wave and pulse wave. With the continuous wave technique the transducer can be aimed along the long axis of the ventricle of the aorta and can record all flow patterns encountered. The pulse wave technique allows simultaneous recording of the Doppler and 2D echocardiography. The pulsed technique allows the localization of a Doppler sample in the area of interest (e.g., mitral and aortic valves). Using these Doppler techniques, a transvalvular gradient across the aortic or mitral valves can be derived, as well as estimation of the pressure and severity of mitral, aortic, and tricuspid valve regurgitations.

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