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Emily Todd
Michelle Rodrigues
 Caileigh Allegrini
 Jenny Alvarado
What does the human
cardiovascular system consists
of?
   The cardiovascular system consists of
    the heart, blood vessels, veins and
    arteries.
Why is the heart important?

   The heart is one of the most important organs in the
    entire human body.
   It is one of the first organs to form. Why? Because it
    when the embryo first starts, it recieves the
    necessary nutrients from its surroundings, but as the
    embryo grows, it becomes hard for the nutrients to
    reach all the cells.
   The heart functions as a pump and is composed of
    muscle.
   The heart pumps blood, which carries all vital
    materials through our body.
   Our entire body relies on the heart.
How does the heart begin?

   The heart derives from Mesoderm.

   Mesoderm is the middle layer of an
    embryo in early development.
The Primitive Heart
  The primitive heart tube is the earliest stage of
   heart development.
 The primitive heart tube consists of the bulbus
   cordis,
a ventricle, atrium, sinus venosus, and
vitelline veins.
 All five embryonic dilatations of the
primitive heart develop into the adult
 structures of the heart.
 The primitive hearts begins beating
once it has formed
Embryonic Heart Looping:
 The linear tube begins to bend upward
  to the right.
 Why does lopping occur?
Looping occurs because it’s the hearts
way of transforming the single heart tube
to a more complex structure with two atria
and two ventricles.
Embryonic Heart Looping:
   The heart continues bending which causes
    chamber structures to form. The heart forms two
    atriums and one large ventricle. As bending
    continues, the heart divides that one large
    ventricle in half, which ultimately leaves you with a
    left and a right ventricle are. The total of chambers
    formed in the heart during looping is 4.
Partitioning of the heart
includes:
 AtrialSeptation:
 Ventricular Septation:
 Atrioventricular Valve formation:
 Division of the outflow tract:
Atrial septation:
   This process occurs during week 5 of development.
   How?
    The septum primum grows from the ventral and
    posterior walls of the atrium.
   The septum secundum forms a ridge on the dorsal
    and posterior walls of the atria, but doesn’t not fuse
    with endocardial cushioning, allowing the foramen
    ovale to remain open, which allows maternal
    circulation until the baby is born.

   EMBED VIDEO HERE
   http://www.youtube.com/watch?v=NCDdoSfdQBo
Ventricular Septation:
   Ventricular septation is a complex
    process involving many surrounding
    structures to form dividing ridges
    positioned at various planes.

   This eventually leads to a complete
    separation of the right and left ventricles.
Development of the outflow
tract:
  What is the outflow tract?
The Outflow tract is a portion of the left
ventricle of the heart through which blood
passes in order to enter the greater
arteries.

 The first indication of a developing
septum is the appearance of two ridges
projecting into the outflow tract from
opposite sides. these ridges spiral in
counter-clockwise direction up the
developing outflow tract.
Stages of development the fetal
heart resembles the structures
of animals hearts
FISH VS EARLY STAGES OF
HEART




      In the early stages when the heart looks
     like a tube, it is similar to a fish heart.
FROG VS TWO CHAMBER
HEART




    when the fetus heart begins to take shape
    and form two chambers, it resembles a
    frog’s heart
TURTLE VS THREE
CHAMBER HEART:




    After the fetal heart has developed two
    atriums and one large ventricle, it looks
    similar to a snake or turtle heart.
Does the heart continue
changing?
 At birth you have a fully functional
  heart, which does not under go any
  drastic changes as you get older.
 As you grow and get bigger, your heart
  gets bigger too.
Invertebrates
 Simple heart and vessels
 Open circulatory system
 Single circulation
Vertebrates
 Heart, blood vessels
  (veins, arteries, capillaries), blood
 Closed circulatory system
 Double circulation
 Increase in metabolic demand
Single vs. Double
           Circulation
 Single: One atrium, one ventricle, the
  heart draws in deoxygenated blood in a
  single atrium and pumps it out to a
  ventricle. Includes a two chambered
  heart
 Double: Pathway that enables the blood
  to flow from the heart to lungs and return
  back to the heart for systemic
  circulation. Includes a three or four
  chambered heart
Fish
 Single circulation
 Four chambers: sinus
  venosus, atrium, ventricle, bulbus
  arteriosus
 One way valves including the sino atrial
  valve and atrioventricular valve prevent
  the backflow of blood between chambers
 Semilunar valve (located in bulbus
  arteriosus) to prevent reverse blood flow
  from the ventral aorta
Evolution
   The transition from aquatic life to
    terrestrial life brought about many
    different accommodations to the new
    modes of life
Amphibians
   Three chambers: right atrium, left atrium,
    one ventricle
   Right and left atrium divided by an
    interatrial septum
   Has a sinus venosus and conus arteriosus
   Has two semilunar valves and an
    atrioventricular valve
   Spiral valve within the conus arteriosus
   The ventricle of a frog heart lacks a septum
    but has a trabeculae instead
   Double circulation
Reptiles
   Three chambers: two atria, one ventricle
   Ventricle divided into the cavum
    venosum, cavum pulmonale, and cavum
    arteriosum
   Cardiac shunt cuts off blood supply to
    lungs
   One-way lunar valves at the conus
    arteriosus and an atrioventricular valve
   Double circulation
   Conus arteriosus and a smaller sinus
    venosus than amphibians and fish
Crocodile
 Four chambers: two atria, two ventricles
 Ventricle has a complete septum
 Unique feature called foramen of
  Panizza that cuts off blood supply to
  lungs while diving
 pair of atrioventricular valves
Mammals & Birds
   Four chambers: two atria, two ventricles
   Double circulation
   Sinus venosus is minimized into a patch of Purkinje fibers
    (AKA sinoatrial node)
   Birds have very small sinus venosus
   Conus arteriosus is transformed into pulmonary and aortic
    trunk
   Considered the perfect heart due to complete internal
    heart septa
   Oxygenated and deoxygenated blood can never mix
   The chance of backflow of blood becomes greater with
    increase in heart chambers
   Valves developed in the heart to prevent backflow of
    blood into the wrong chambers
Mammalian Heart Valves
 The human heart has 4 heart valves:
 Bicuspid mitral valve
 Tricuspid valve (right atrioventricular
  valve)
 Aortic valve
 Pulmonary valve (semilunar valve)
Heart Valves
 Bicuspid mitral valve: separates the
  left atrium from the left ventricle
 Tricuspid valve: separates the right
  atrium from the right ventricle
 Aortic valve: separates the base of
  the left ventricle with the aorta
 Pulmonary valve: separates the
  base of the right ventricle with the
  pulmonary artery
Anatomy & Function of Mitral
              Valve
   Prevents the backflow of blood into the atrium
   2 cusps
   4-6 cm2 in size
   Opening surrounded by fibrous ring known as the
    mitral valve annulus
   Valve cusps do not balloon into the left atrium
    because of the chordae tendineae
   Chordae tendineae are attached to papillary muscles
    and valve cusps
   The intraventricular pressure forces the valve to
    close when the left ventricle contracts
   Tendons help the cusps fit together and prevent the
    valve from opening in the wrong direction
Mitral Valve Prolapse (MVP)
 Most common heart valve abnormality
 Effects mostly women between the
  ages of 20-40
 One or both of the flaps are too large
 Mitral valve does not close evenly with
  each heartbeat
 Causes regurgitation (the backward
  leaking of blood) – leads to heart
  murmur
Symptoms & Treatments
   Symptoms: chest pain, irregular
    heartbeat, increased heart beat after exertion, other
    blood flow complications
   In rare cases: formation of blood clots on the
    valve, puts patient at high risk for stroke
   Treatment: medications, specifically beta-
    blocker, surgery to repair or replace the mitral valve
   Severe mitral regurgitation often leads to an
    enlarged heart causing heart failure
   Severe cases where the valve cannot be
    repaired, only replaced, the patient is subject to a
    lifetime of blood thinners to prevent blood clotting.
Physiology of the heart
 Conduction system
 Transportation of the blood in the heart
Conduction system
       How the heart contracts!
   heart contracts as a direct result of electrical
    potential that travels through the myocardium
    cells of the heart.

   There are 5 components to the conduction
    system that aid in the contraction of the heart:

                          Sinatrial (SA) node

                         Atrioventricular (AV) node
                          Bundle of His
                          Left/Right bundle branches
Conduction system
   The SA node ( the pacemaker) located at the top of the right
    atria is the portion of this system that generates the impulse;
    providing the stimulus for contraction.

   The impulse continues to the AV node. At the AV node which is
    located at the bottom portion of the right atria, the atria is
    contracted and the electrical impulse is paused, because the
    atria needs to complete its contraction.

   Once the contraction is complete the electrical impulse is
    passed through the bundle of his, and then to the left/ right
    bundle branches that are located within the interventricular
    septum, and lastly to the Purkinje fibers.

   The Purkinje fibers are located in the muscle walls of the
    ventricle. Since the ventricle of the heart is very large it is
    essential that the Purkinje fibers depolarize the contractile cells
    of both ventricles; causing them to contract.

                http://www.youtube.com/watch?v=te_SY3MeWys
Transportation of the Blood in
             the Heart
   Occurs in 2 phases: Diastole Phase ( relaxation of the atria and the ventricles)

                             Systole Phase ( Ventricles contract)

   In the Diastole Phase, which occurs first in the heart represents the relaxation of the
    atria and ventricle as it refills with blood. During this time the atrioventricular valves are
    open.

   Deoxygenated blood enters through the superior and inferior vena cava to the right
    atria. Since the atrioventricular valve (which separates the atria from the ventricle) is
    opened, the blood can continue through the atria into the right ventricle.

   As the blood enters through the right ventricle an impulse from the SA node is created
    and allows the right atria to contract. The right atrium empties out all its blood into the
    right ventricle, and the atrioventricular valve closes to prevent the back flow of blood.

   At the right ventricle and electrical impulse from the Purkinje fibers allows the ventricle
    to contract, this is the beginning of the Systole phase which occurs when the ventricles
    are contracted. The blood pushes through the opened pulmonary valve (one of the
    semi lunar valves) to the pulmonary artery.

   The deoxygenated blood then travels to the lungs where carbon dioxide is released
    and oxygen is absorbed.
Transportation of the Blood in
             the Heart
   Once oxygenated the blood returns to the heart it enters
    in through the pulmonary veins and there is another
    Diastole phase. The pulmonary veins carrying oxygen rich
    blood continues flowing to the left atrium. The mitral valve
    (one of the atrioventricular valves) is opened, so blood
    can easily flow to the left ventricle. Once again the SA
    node triggers an impulse and contracts, so does the left
    atria. The blood is emptied in the left ventricle and the
    mitral valve closes.

   From the left ventricle the Systole phase occurs. The
    Purkinje fibers contract and the left ventricle moves blood
    through the aortic valve (one of the semi lunar valves) to
    the aorta, where it is distributed to the rest of the body.



     http://www.youtube.com/watch?v=JA0Wb3gc4mE
References
   Amsel, Sheri. “Glossary (What Words Mean) with Pictures!.” Bicuspid valve (mitral
    valve). Exploring Nature Educational Resource. © 2005 - 2012. December 14,
    2012.<http://exploringnature.org/db/detail.php?dbID=13&detID=188>
   What the Health Magazine. [Internet]. Published by What the Health Magazine. [cited
    2012 Dec 10] Available from
    http://whatthehealthmag.files.wordpress.com/2011/02/818pills.jpg
   Warkentin, D.S. 2012. Mitral Valve Prolapse [Internet]. Summit Medical Group; [cited
    2012 Dec 10]. Published by RelayHealth. Available from
    http://www.summitmedicalgroup.com/library/adult_health/car_mitral_valve_prolapse/
   Cardiac Conduction System [Internet]. 2009 Nov 21.):John Winters;.
    Available from:
    http://ecg-experts.blogspot.com/2009/11/cardiac-conduction-system.html

    mdmedicine . 2011 April 11. Heart Conduction System [Internet] .
    Available from:
    http://mdmedicine.wordpress.com/2011/04/24/heart-conduction-system/

    Wapcaplet . 2006 June 6. Diagram of the Human Heart
    [Internet].:Sodipodi. Available from:
    http://en.wikipedia.org/wiki/File:Diagram_of_the_human_heart_%28cropped%29.svg
References
   Bailey R. Circulatory System-Types of Circulatory Systems [Internet]. Education
    Biology. About.com; [cited 2012 Nov 29]. Available
    from:http://biology.about.com/od/organsystems/a/circulatorysystem.htm
   Di Salvo TG, Acker MA, Dec GW, Byrne JG. 2010. Mitral valve surgery in
    advanced heart failure. J Am Coll Cardiol 55(4):271-82.
   Franklin CE. Axelsson M. Physiology: An actively controlled heart valve. Nature
    2000 Aug 24;406(6798):847-8.
   Kardong KV. Vertebrates: comparative anatomy, function, evolution. 6 ed. New
    York: McGraw-Hill; 2002. Pp. 451-502.

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The cardiovascular system

  • 1. Emily Todd Michelle Rodrigues Caileigh Allegrini Jenny Alvarado
  • 2. What does the human cardiovascular system consists of?  The cardiovascular system consists of the heart, blood vessels, veins and arteries.
  • 3. Why is the heart important?  The heart is one of the most important organs in the entire human body.  It is one of the first organs to form. Why? Because it when the embryo first starts, it recieves the necessary nutrients from its surroundings, but as the embryo grows, it becomes hard for the nutrients to reach all the cells.  The heart functions as a pump and is composed of muscle.  The heart pumps blood, which carries all vital materials through our body.  Our entire body relies on the heart.
  • 4. How does the heart begin?  The heart derives from Mesoderm.  Mesoderm is the middle layer of an embryo in early development.
  • 5. The Primitive Heart  The primitive heart tube is the earliest stage of heart development.  The primitive heart tube consists of the bulbus cordis, a ventricle, atrium, sinus venosus, and vitelline veins.  All five embryonic dilatations of the primitive heart develop into the adult structures of the heart.  The primitive hearts begins beating once it has formed
  • 6. Embryonic Heart Looping:  The linear tube begins to bend upward to the right.  Why does lopping occur? Looping occurs because it’s the hearts way of transforming the single heart tube to a more complex structure with two atria and two ventricles.
  • 7. Embryonic Heart Looping:  The heart continues bending which causes chamber structures to form. The heart forms two atriums and one large ventricle. As bending continues, the heart divides that one large ventricle in half, which ultimately leaves you with a left and a right ventricle are. The total of chambers formed in the heart during looping is 4.
  • 8. Partitioning of the heart includes:  AtrialSeptation:  Ventricular Septation:  Atrioventricular Valve formation:  Division of the outflow tract:
  • 9. Atrial septation:  This process occurs during week 5 of development.  How?  The septum primum grows from the ventral and posterior walls of the atrium.  The septum secundum forms a ridge on the dorsal and posterior walls of the atria, but doesn’t not fuse with endocardial cushioning, allowing the foramen ovale to remain open, which allows maternal circulation until the baby is born.  EMBED VIDEO HERE  http://www.youtube.com/watch?v=NCDdoSfdQBo
  • 10. Ventricular Septation:  Ventricular septation is a complex process involving many surrounding structures to form dividing ridges positioned at various planes.  This eventually leads to a complete separation of the right and left ventricles.
  • 11. Development of the outflow tract:  What is the outflow tract? The Outflow tract is a portion of the left ventricle of the heart through which blood passes in order to enter the greater arteries.  The first indication of a developing septum is the appearance of two ridges projecting into the outflow tract from opposite sides. these ridges spiral in counter-clockwise direction up the developing outflow tract.
  • 12. Stages of development the fetal heart resembles the structures of animals hearts
  • 13. FISH VS EARLY STAGES OF HEART In the early stages when the heart looks like a tube, it is similar to a fish heart.
  • 14. FROG VS TWO CHAMBER HEART when the fetus heart begins to take shape and form two chambers, it resembles a frog’s heart
  • 15. TURTLE VS THREE CHAMBER HEART: After the fetal heart has developed two atriums and one large ventricle, it looks similar to a snake or turtle heart.
  • 16. Does the heart continue changing?  At birth you have a fully functional heart, which does not under go any drastic changes as you get older.  As you grow and get bigger, your heart gets bigger too.
  • 17. Invertebrates  Simple heart and vessels  Open circulatory system  Single circulation
  • 18. Vertebrates  Heart, blood vessels (veins, arteries, capillaries), blood  Closed circulatory system  Double circulation  Increase in metabolic demand
  • 19. Single vs. Double Circulation  Single: One atrium, one ventricle, the heart draws in deoxygenated blood in a single atrium and pumps it out to a ventricle. Includes a two chambered heart  Double: Pathway that enables the blood to flow from the heart to lungs and return back to the heart for systemic circulation. Includes a three or four chambered heart
  • 20. Fish  Single circulation  Four chambers: sinus venosus, atrium, ventricle, bulbus arteriosus  One way valves including the sino atrial valve and atrioventricular valve prevent the backflow of blood between chambers  Semilunar valve (located in bulbus arteriosus) to prevent reverse blood flow from the ventral aorta
  • 21. Evolution  The transition from aquatic life to terrestrial life brought about many different accommodations to the new modes of life
  • 22. Amphibians  Three chambers: right atrium, left atrium, one ventricle  Right and left atrium divided by an interatrial septum  Has a sinus venosus and conus arteriosus  Has two semilunar valves and an atrioventricular valve  Spiral valve within the conus arteriosus  The ventricle of a frog heart lacks a septum but has a trabeculae instead  Double circulation
  • 23. Reptiles  Three chambers: two atria, one ventricle  Ventricle divided into the cavum venosum, cavum pulmonale, and cavum arteriosum  Cardiac shunt cuts off blood supply to lungs  One-way lunar valves at the conus arteriosus and an atrioventricular valve  Double circulation  Conus arteriosus and a smaller sinus venosus than amphibians and fish
  • 24. Crocodile  Four chambers: two atria, two ventricles  Ventricle has a complete septum  Unique feature called foramen of Panizza that cuts off blood supply to lungs while diving  pair of atrioventricular valves
  • 25. Mammals & Birds  Four chambers: two atria, two ventricles  Double circulation  Sinus venosus is minimized into a patch of Purkinje fibers (AKA sinoatrial node)  Birds have very small sinus venosus  Conus arteriosus is transformed into pulmonary and aortic trunk  Considered the perfect heart due to complete internal heart septa  Oxygenated and deoxygenated blood can never mix  The chance of backflow of blood becomes greater with increase in heart chambers  Valves developed in the heart to prevent backflow of blood into the wrong chambers
  • 26. Mammalian Heart Valves  The human heart has 4 heart valves:  Bicuspid mitral valve  Tricuspid valve (right atrioventricular valve)  Aortic valve  Pulmonary valve (semilunar valve)
  • 27. Heart Valves  Bicuspid mitral valve: separates the left atrium from the left ventricle  Tricuspid valve: separates the right atrium from the right ventricle  Aortic valve: separates the base of the left ventricle with the aorta  Pulmonary valve: separates the base of the right ventricle with the pulmonary artery
  • 28. Anatomy & Function of Mitral Valve  Prevents the backflow of blood into the atrium  2 cusps  4-6 cm2 in size  Opening surrounded by fibrous ring known as the mitral valve annulus  Valve cusps do not balloon into the left atrium because of the chordae tendineae  Chordae tendineae are attached to papillary muscles and valve cusps  The intraventricular pressure forces the valve to close when the left ventricle contracts  Tendons help the cusps fit together and prevent the valve from opening in the wrong direction
  • 29. Mitral Valve Prolapse (MVP)  Most common heart valve abnormality  Effects mostly women between the ages of 20-40  One or both of the flaps are too large  Mitral valve does not close evenly with each heartbeat  Causes regurgitation (the backward leaking of blood) – leads to heart murmur
  • 30. Symptoms & Treatments  Symptoms: chest pain, irregular heartbeat, increased heart beat after exertion, other blood flow complications  In rare cases: formation of blood clots on the valve, puts patient at high risk for stroke  Treatment: medications, specifically beta- blocker, surgery to repair or replace the mitral valve  Severe mitral regurgitation often leads to an enlarged heart causing heart failure  Severe cases where the valve cannot be repaired, only replaced, the patient is subject to a lifetime of blood thinners to prevent blood clotting.
  • 31. Physiology of the heart  Conduction system  Transportation of the blood in the heart
  • 32. Conduction system How the heart contracts!  heart contracts as a direct result of electrical potential that travels through the myocardium cells of the heart.  There are 5 components to the conduction system that aid in the contraction of the heart: Sinatrial (SA) node Atrioventricular (AV) node Bundle of His Left/Right bundle branches
  • 33. Conduction system  The SA node ( the pacemaker) located at the top of the right atria is the portion of this system that generates the impulse; providing the stimulus for contraction.  The impulse continues to the AV node. At the AV node which is located at the bottom portion of the right atria, the atria is contracted and the electrical impulse is paused, because the atria needs to complete its contraction.  Once the contraction is complete the electrical impulse is passed through the bundle of his, and then to the left/ right bundle branches that are located within the interventricular septum, and lastly to the Purkinje fibers.  The Purkinje fibers are located in the muscle walls of the ventricle. Since the ventricle of the heart is very large it is essential that the Purkinje fibers depolarize the contractile cells of both ventricles; causing them to contract. http://www.youtube.com/watch?v=te_SY3MeWys
  • 34. Transportation of the Blood in the Heart  Occurs in 2 phases: Diastole Phase ( relaxation of the atria and the ventricles) Systole Phase ( Ventricles contract)  In the Diastole Phase, which occurs first in the heart represents the relaxation of the atria and ventricle as it refills with blood. During this time the atrioventricular valves are open.  Deoxygenated blood enters through the superior and inferior vena cava to the right atria. Since the atrioventricular valve (which separates the atria from the ventricle) is opened, the blood can continue through the atria into the right ventricle.  As the blood enters through the right ventricle an impulse from the SA node is created and allows the right atria to contract. The right atrium empties out all its blood into the right ventricle, and the atrioventricular valve closes to prevent the back flow of blood.  At the right ventricle and electrical impulse from the Purkinje fibers allows the ventricle to contract, this is the beginning of the Systole phase which occurs when the ventricles are contracted. The blood pushes through the opened pulmonary valve (one of the semi lunar valves) to the pulmonary artery.  The deoxygenated blood then travels to the lungs where carbon dioxide is released and oxygen is absorbed.
  • 35. Transportation of the Blood in the Heart  Once oxygenated the blood returns to the heart it enters in through the pulmonary veins and there is another Diastole phase. The pulmonary veins carrying oxygen rich blood continues flowing to the left atrium. The mitral valve (one of the atrioventricular valves) is opened, so blood can easily flow to the left ventricle. Once again the SA node triggers an impulse and contracts, so does the left atria. The blood is emptied in the left ventricle and the mitral valve closes.  From the left ventricle the Systole phase occurs. The Purkinje fibers contract and the left ventricle moves blood through the aortic valve (one of the semi lunar valves) to the aorta, where it is distributed to the rest of the body. http://www.youtube.com/watch?v=JA0Wb3gc4mE
  • 36. References  Amsel, Sheri. “Glossary (What Words Mean) with Pictures!.” Bicuspid valve (mitral valve). Exploring Nature Educational Resource. © 2005 - 2012. December 14, 2012.<http://exploringnature.org/db/detail.php?dbID=13&detID=188>  What the Health Magazine. [Internet]. Published by What the Health Magazine. [cited 2012 Dec 10] Available from http://whatthehealthmag.files.wordpress.com/2011/02/818pills.jpg  Warkentin, D.S. 2012. Mitral Valve Prolapse [Internet]. Summit Medical Group; [cited 2012 Dec 10]. Published by RelayHealth. Available from http://www.summitmedicalgroup.com/library/adult_health/car_mitral_valve_prolapse/  Cardiac Conduction System [Internet]. 2009 Nov 21.):John Winters;. Available from: http://ecg-experts.blogspot.com/2009/11/cardiac-conduction-system.html mdmedicine . 2011 April 11. Heart Conduction System [Internet] . Available from: http://mdmedicine.wordpress.com/2011/04/24/heart-conduction-system/ Wapcaplet . 2006 June 6. Diagram of the Human Heart [Internet].:Sodipodi. Available from: http://en.wikipedia.org/wiki/File:Diagram_of_the_human_heart_%28cropped%29.svg
  • 37. References  Bailey R. Circulatory System-Types of Circulatory Systems [Internet]. Education Biology. About.com; [cited 2012 Nov 29]. Available from:http://biology.about.com/od/organsystems/a/circulatorysystem.htm  Di Salvo TG, Acker MA, Dec GW, Byrne JG. 2010. Mitral valve surgery in advanced heart failure. J Am Coll Cardiol 55(4):271-82.  Franklin CE. Axelsson M. Physiology: An actively controlled heart valve. Nature 2000 Aug 24;406(6798):847-8.  Kardong KV. Vertebrates: comparative anatomy, function, evolution. 6 ed. New York: McGraw-Hill; 2002. Pp. 451-502.