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  <head>
    <title>086-01 Cardiovascular and respiratory organogenesis, fetal shunts, and congenital mechanisms</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Cardiovascular and respiratory organogenesis">
      <outline text="Heart tube formation and looping">
        <outline text="First to function: diffusion cannot support the embryo"/>
        <outline text="Cardiogenic mesoderm cranial to oropharyngeal membrane"/>
        <outline text="Folding brings paired regions ventrally together">
          <outline text="Endothelial tubes fuse into primitive heart tube"/>
          <outline text="Splanchnic mesoderm forms myocardium"/>
          <outline text="Cardiac jelly separates myocardium and endocardium"/>
        </outline>
        <outline text="Epicardium spreads from proepicardial tissue"/>
        <outline text="Sinus venosus to truncus arteriosus, inflow to outflow"/>
        <outline text="Beats in fourth week, before septation"/>
        <outline text="Rightward bulboventricular loop">
          <outline text="Ventricles ventrocaudal, atria dorsocranial"/>
          <outline text="Sets position, not chamber identity"/>
          <outline text="Abnormal looping gives discordant connections"/>
        </outline>
      </outline>
      <outline text="Venous inflow and atrial remodelling">
        <outline text="Right horn enlarges into sinus venarum"/>
        <outline text="Left horn becomes coronary sinus and oblique vein"/>
        <outline text="Crista terminalis marks smooth-trabeculated junction"/>
        <outline text="Pulmonary veins form smooth posterior left atrium">
          <outline text="Anomalous drainage into systemic veins"/>
          <outline text="Obstruction and mixing set presentation"/>
        </outline>
      </outline>
      <outline text="Atrial septation and foramen ovale">
        <outline text="Septum primum leaves ostium primum"/>
        <outline text="Perforations coalesce as ostium secundum"/>
        <outline text="Septum secundum on right leaves foramen ovale"/>
        <outline text="Septum primum flap allows right-to-left flow"/>
        <outline text="Birth: rising left-atrial pressure closes flap">
          <outline text="Incomplete fusion: probe-patent foramen ovale"/>
          <outline text="True septal defect: deficient tissue, sustained shunt"/>
        </outline>
      </outline>
      <outline text="Cushions, ventricular septum, and valves">
        <outline text="Cushions: matrix swelling, endothelial-mesenchymal transition">
          <outline text="Divide atrioventricular canal, form leaflets"/>
          <outline text="Cushion defects: septal defects plus valve anomalies"/>
        </outline>
        <outline text="Muscular septum grows up from ventricular floor"/>
        <outline text="Membranous part closes interventricular foramen">
          <outline text="Defects most often membranous"/>
          <outline text="Large left-to-right shunt, pulmonary vascular disease">
            <outline text="Eventual shunt reversal"/>
          </outline>
        </outline>
        <outline text="Valves from excavated swellings and cushions">
          <outline text="Cusp number, fusion, or matrix errors"/>
          <outline text="Stenosis or regurgitation may appear years later"/>
        </outline>
      </outline>
      <outline text="Outflow tract and conotruncal anomalies">
        <outline text="Neural-crest ridges spiral into aorticopulmonary septum"/>
        <outline text="Migration or rotation defects">
          <outline text="Persistent truncus, interrupted arch, double outlet"/>
        </outline>
        <outline text="Tetralogy: anterior outflow septum displacement">
          <outline text="Outflow obstruction, septal defect, overriding aorta"/>
          <outline text="Secondary right-ventricular hypertrophy"/>
        </outline>
        <outline text="Transposition: failed spiralling">
          <outline text="Parallel circuits need mixing to survive"/>
        </outline>
      </outline>
      <outline text="Arch, venous, and coronary vessels">
        <outline text="Third arch: common and proximal internal carotid"/>
        <outline text="Left fourth: aortic arch; right fourth: subclavian"/>
        <outline text="Sixth: pulmonary arteries; left distal is ductus"/>
        <outline text="Coarctation narrows aorta near ductal region"/>
        <outline text="Vascular rings compress trachea and oesophagus"/>
        <outline text="Vitelline veins: sinusoids, portal system, caval part"/>
        <outline text="Cardinal remodelling explains venous variants"/>
        <outline text="Coronary stems must enter correct sinuses">
          <outline text="Between great vessels or from pulmonary artery"/>
        </outline>
      </outline>
      <outline text="Airway budding and larynx">
        <outline text="Respiratory diverticulum from ventral foregut, week four"/>
        <outline text="Tracheoesophageal folds separate the tubes">
          <outline text="Oesophageal atresia with distal fistula"/>
          <outline text="Polyhydramnios, choking, gastric distension"/>
        </outline>
        <outline text="Larynx from fourth and sixth arches, vagal supply"/>
        <outline text="Failed recanalisation: webs or atresia"/>
      </outline>
      <outline text="Lung branching and maturation">
        <outline text="Endoderm epithelium, splanchnic mesoderm wall"/>
        <outline text="Epithelial-mesenchymal signals drive branching"/>
        <outline text="Pseudoglandular: airways branch, no gas exchange"/>
        <outline text="Canalicular: vessels, respiratory bronchioles"/>
        <outline text="Saccular: thin epithelium near capillaries"/>
        <outline text="Alveolarisation continues into childhood"/>
        <outline text="Surfactant from type two pneumocytes">
          <outline text="Deficiency: atelectasis, low compliance"/>
          <outline text="Antenatal glucocorticoids accelerate maturation"/>
        </outline>
      </outline>
      <outline text="Lung growth and diaphragm">
        <outline text="Needs space, fluid, movement, vessels, branching"/>
        <outline text="Oligohydramnios or absent urine: hypoplasia"/>
        <outline text="Posterolateral diaphragmatic hernia compresses lung">
          <outline text="Hypoplasia and pulmonary hypertension"/>
          <outline text="Severity follows lung, not hole size"/>
        </outline>
      </outline>
      <outline text="Flow-path reasoning">
        <outline text="Connect, separate, remodel, mature"/>
        <outline text="Ask which flow path failed"/>
      </outline>
    </outline>
  </body>
</opml>
