Background: Understanding of cardiac outflow tract (OFT) remodeling is essential to explain repositioning of the aorta and pulmonary orifice. In wild type embryos (E9.5-14.5), second heart field contribution (SHF) to the OFT was studied using expression patterns of Islet 1, Nkx2.5, MLC-2a, WT-1, and 3D-reconstructions. Abnormal remodeling was studied in VEGF120/120 embryos. Results: In wild type, Islet 1 and Nkx2.5 positive myocardial precursors formed an asymmetric elongated column almost exclusively at the pulmonary side of the OFT up to the pulmonary orifice. In VEGF120/120 embryos, the Nkx2.5-positive mesenchymal population was disorganized with a short extension along the pulmonary OFT. Conclusions: We postulate that normally the pulmonary trunk and orifice are pushed in a higher and more frontal position relative to the aortic orifice by asymmetric addition of SHF-myocardium. Deficient or disorganized right ventricular OFT expansion might explain cardiac malformations with abnormal position of the great arteries, such as double outlet right ventricle. Developmental Dynamics 241:1413-1422, 2012. V C 2012 Wiley Periodicals, Inc.Key words: cardiac development; outflow tract; gene expression
Key findings:The addition of Nkx2.5-positive myocardial precursors from the anterior heart field occurs during normal development in an asymmetrical fashion, predominantly below the left branch of the 6th pharyngeal arch artery. The continued addition of right-sided myocardium during normal development results in movement without spiralization of the OFT in which the pulmonary trunk orifice is pushed in a rightward and anterior direction, a mechanism referred to as ''pulmonary push.'' Deficient or disorganized positioning of the Nkx2.5-positive precursors, as was observed in VEGF120/120 mutants might explain cardiac malformations with side-by-side position of the great arteries, such as double outlet right ventricle.