38. Septation of the inflow tract.

- Between DD 27-31 septation of the heart commences.

- From the ceiling of the atrium will appear septum primum, which tends to unite with the
septum intermediate.
- However, between them there is a connective space between the left and the right side called
foramen primum.
- Later, in the superior part of septum primum, foramen secundum will appear through the
resorption of cells.
- Afterwards, septum secundum will appear, incomplete , concave inferiorly, situated on the right
side of septum primum.
- It however, does not reach the septum intermedius.
- Septum secundum and foramen secundum will delimitate foramen ovale, which allows the
blood to move from the right to the left atrium* until birth when the pressure of the left side
increases and foramen ovale is closed.
- During the first respiration/ breath, septum primum attaches itself to septum secundum due to
the growth in pressure in the left atrium.
- The free margin of septum secundum becomes an extension of the fossa ovale in the adult
heart.
- With the septation of the atrium, the venous sinus opens up into the right atrium through the
sinus trial ostium/ opening.
- Starting with the evolution of the venous sinus, the left horn will atrophy and only the coronary
sinus (from the anterior part) will remain together with the Marshall oblique vein (from the
distal part). The right horn will open up in the right atrium .
- The entry orifice of the right horn, called the sinuatrial orifice, presents on each side a valvular
fold (rightb& left venous valves), which will fusion dorso-cranially forming the septum spurium.
- The left valve will participate at the edification of septum primum, and the right valve will form
the inferior vena cava valve & the sinuatrial ostium/opening.
- From an evolution point of view, the right horn of the venous sinus will incorporate itself in the
right atrium & it will form its sinusal part.
SUBJECT 38 - Septation of inflow tract
Development of sinus venosum
In the middle of 4th week, sinus venosum recievs blood from Right and left Horn
Each horn receives blood from three important veins:
-Vitelline (paired) vein – from Yolc sac
-Common cardinal vein – from embryo itself
-Umbilical vein (paired)– from placenta

The opening to the heart will be called, sinoatrial junction.

The junction will initially become narrower and located to the right side, where we will have the right
venous valve and together with the left venous valve will fuse and form septum spurium which initially
becomes the atrial septum.
The right venous valve will later form, the eustachian valve of the inferior vena cava and thebesian
valve of the coronary sinus, as the left horn “disappears”
The left horn will have a less important role and in adult remain as coronary sinus and oblique vein of
left atrium.
This formation will lead to a “right-left shunt” of the blood.
In the superior part of the right atrium, the SVC will be formed, and from the intersepto-valvular space.

Septation
- Septation of the heart comes across between the 4th and the 7th W of fetal life, from
D27-to D37, as the embryo grows from 5mm to 16-17mm, it all occurs at the same
time.
- Septum formation occurs in 2 manners:

1.Atrioventricular septa
 The septum involves active growing tissues by 2 endocardial cushions dividing
lumen into 2 separate atrioventricular canals and valves.
 The formation of endocardial tissue depends on, extracellular matrices, cell
migration and proliferation of overlying endocardial cells.
 The atrioventricular cushion derives from overlying endocardial cell
 The conotrunchal cushions, forming septation of outflow tract and
aortic/pulmonary channels derives from neural crest cells.

2. Atria/ventricular septa
 At the end of 4th week, the first portion of septum primum forms as a crest
grows from the common atrial roof into the lumen and initially towards the
atrioventricular cushion, leaving an opening called ostium primum.
 As septum primum grows, proliferation of mesenchyme forms the Dorsal
mesenchyme protrusion (DMP) that also will grow toward the
 atrioventricular canal on the side of the left atrium and form the opening of
the pulmonary veins.
 Initially, Ostium primum will be closed due to apoptosis and Ostium
secundum will form as an right left shunt is still required to maintain the
physiological requirements.
 As the atrial start bulging and incorporate the sinus horn during looping, a
new fold, septum secundum appears.
 Septum secundum will overlap the foramen ovale and will work as a “door or
valve”, which, initially, will be “closed” or pulled against the atrial septal wall.
 In the fully developed right atria, the trabeculated right atria contain
pectinate muscle that will form the right atrial appendage, and the smooth-
walls of sinus venarum originate from right horn of sinus venosus. (The left
atria smooth wall will originate from pulmonary vein).