Role of extracardiac factors in heart development

Many factors extrinsic to the developing heart play important roles in determining its final form. The neural crest has been shown to provide ectomesenchyme to the pharyngeal apparatus and outflow tract, as well as the postganglionic innervation of the heart. Ablation of the neural crest providing ectomesenchyme to the outflow tract results in various cardiac malformations. These malformations have in common either outflow and/or inflow tract malalignment. Although the reason for this malalignment is not understood, it is thought that hemodynamic parameters during early cardiac morphogenesis may be disrupted causing cardiac dysmorphogenesis. The most likely area for this alteration to occur is in the pharyngeal apparatus which houses the aortic arch arteries. Various possibilities are discussed. The innervation of the heart by neural crest-derived autonomic neurons and nodose placode-derived sensory neurons is outlined, and the interactions between the two progenitive sites is discussed.