If the baby is healthy and cheerful, he plays, eats well and grows. The time comes for a planned visit to the pediatrician, and suddenly the diagnosis is open oval window. First, panic and anxiety, then the understanding that this is not the most terrible disease- you can live with her full life, but with minor restrictions.

Sometimes a mother finds out about her baby’s open oval “window” while he is still a baby. It is important to understand that this is not a sentence, but a structural feature of the organ, which in certain cases requires treatment. The baby needs to be helped to accept his condition and peculiarity and try not to put unnecessary pressure on him.

A patent foramen ovale is not considered a heart defect and you can live with it

What is a patent foramen ovale in the heart?

In the mother's womb, the fetus grows and develops. The following changes occur in the heart, which have the following effect: important for its further development:

1. An unborn baby has a small “hole” between the left and right atrium - this is a normal variant. When its size is insufficient, or it is absent, the baby may die before birth.
2. A valve is formed on the left atrium.
3. At the moment of birth, the valve is closed by the pressure created by the baby's first cry.
4. The valve adheres to the wall interatrial septum, isolating right atrium from the left.

Sometimes the valve does not have time to form, and its size is too small to isolate the right and left atria - the open foramen ovale in the heart does not heal. And now, when the heart works, blood will flow from one atrium to another. Such a newborn is diagnosed with minor cardiac anomaly (MACD).

An open foramen ovale is not a defect; there is no need to overprotect the child and deprive him of the opportunity to explore the world. If the hole does not close immediately, there is no need to worry and limit the baby - perhaps it will close later.

Norms for LLC sizes in newborns

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There are general standard indicators for the size of an open oval window. It is important to understand that the presence of pathology can only be determined by a doctor after comprehensive examination. Basic indicators of the norm:

• when diagnosed using ultrasound, the size of the hole between the left and right atrium is up to 2 mm;
• with contrast echocardiography – with this method Ultrasound during intravenous administration shaken saline solution should not allow microscopic bubbles to enter the left atrium from the right;
• with echocardiography through the esophagus, the size of the gap between the two atria is up to 2 mm;
• with radiography chest– absence of expansion of the heart shadow on the right side.

These indicators are subjective, each organism is individual, and it is possible to make a diagnosis or talk about the likelihood of surgical intervention only after a thorough examination.

The primary task is to do an ultrasound and x-ray, consult with several doctors and develop a set of measures to improve the condition of your baby.

At what age should the oval window close completely?

In half of newborn children, the oval window in the heart closes in the first year of life, usually no earlier than 3 months after birth, less often the process stretches up to 5 years. There are cases when a closed oval window opens under the influence of negative factors in adulthood. Many children with an open oval window feel comfortable and lead an active life.

In 1930, a study was conducted in which the activity of thousands of children's hearts was studied, of which 350 were found to have an open foramen ovale. According to the results of a recent study, this number has already increased by 40%, which is also facilitated by poor ecology.

When can this be considered a pathology?

There is a significant difference between the structural features of the heart and its pathology. Deserves special attention and careful medical observation of a child whose heart window size is more than 2 mm.

The anomaly may not manifest itself for many years, but may be diagnosed in infancy

What is considered pathology? Scroll characteristic symptoms in children from 0 to 7 years:

• heart murmurs;
• frequent intermittent breathing;
• cardiopalmus;
• inertia and lethargy of the baby, weakness and fatigue;
• slowness of development;
• severe headaches, dizziness;
• fainting, especially with a lack of oxygen;
• bluish skin on the face in the area of ​​the nasolabial triangle.

Reasons for untimely closure of the oval window

The main factor influencing the occurrence of heart pathology in the form of an open gap between the right and left atrium is the characteristics of intrauterine development. Doctors talk about the dangers of alcohol during pregnancy for a reason, and cigarette packs are full of corresponding warnings.

Pregnancy is a responsibility, and in many cases it depends on the expectant mother whether her baby will be healthy or will have to face difficulties.

Reasons for untimely closure of the oval window:

1. Abuse of alcohol and cigarettes by a pregnant woman.
2. Interaction with toxic, harmful substances.
3. Bad ecology.
4. Experiences and stress of the expectant mother.
5. Negative Impact medical supplies during intrauterine development.
6. Heredity, genetic predisposition. A patent foramen ovale in a child's heart does not correspond to the size of the valve. The baby will grow, and the discrepancy in the heart will increase.
7. The newborn was born premature (before the due date). An open foramen ovale is normal in newborns, but if the baby was born at the wrong time, then the organ has not yet formed, and there is a risk that the opening in the heart does not fit standard indicator in 2 mm.
8. Severe cough caused by illness respiratory tract and lungs. Coughing and pressure do not close the gap, but may increase in size.
9. Active physical activity. By increasing the load on the heart, especially if it was preceded by a recent illness, the flow of blood from one atrium to another increases. During exercise, the pressure increases, and the gap between the left and right atria widens.
10. Other heart diseases (for example, open ductus arteriosus, mitral or tricuspid valve defects).
11. Disproportional growth of the child and the valve of his heart, causing the “hole” between the left and right atrium to increase.

A patent foramen ovale in the heart is almost always diagnosed in premature newborns.

How dangerous is the pathology?

The risk of developing pathology for a baby is low - complications in the heart’s activity usually appear either in utero or immediately after birth. IN younger age Doctors are in no hurry to diagnose complications - the individual characteristics of such a complex organ allow you to wait until 5 years before seriously starting to worry.

A “hole” in a child’s heart between both atria causes hypertension if it big size, then complications and disturbances in the activity of the child’s body are possible:

1. Blood clot formation. The clot in the heart cavity enlarges and breaks away from the vessel walls, which leads to blockage of the blood vessels.
2. Brain circulatory disorders. They are provoked by hypertension due to an unclosed oval window.
3. A heart attack is a consequence of circulatory disorders, thrombosis and lack of oxygen. Manifests itself in organ necrosis.
4. Stroke - form acute disorder blood flow of the brain, a broader concept of infarction.

In a child with a heart abnormality, the arterial pressure

Features of treatment and prognosis

In the absence of pathology, there is usually no need for drug treatment- try not to give the child strong physical activity, treat acute respiratory viral infections and acute respiratory infections in a timely manner; for concomitant heart diseases, therapy and medical supervision are required. Until a peculiarity of the baby’s body is recognized as a pathology, it is necessary to reduce the risk of concomitant diseases and factors that could provoke this.

If the size of the oval window in a child exceeds 4 mm, this is a reason for a thorough examination. In cases where it is more than 9 mm and the blood output exceeds the norm, an operation using the endovascular technique is indicated, which includes the following steps:

• a special catheter is inserted through the femoral artery;
• Carrying out control using ultrasound and ECG, the valves are glued together, and the hole of the oval window is closed with a special plaster;
• the catheter is carefully removed;
• the plaster remaining inside seals the gap between the valve and the septum;
• the patch dissolves;
• carried out within 6 months antiviral treatment– a course of antibiotics is prescribed.

This method is effective and efficient; it will allow the child to lead a full, active life. Special care is required during the first month after the procedure. The first six months after the operation, physical rest is necessary, it is necessary to exclude the possibility of viral diseases, avoid visiting public places. You should provide the little patient with psychological support and be attentive to him, preventing stress and anxiety.

A diagnosis of a patent foramen ovale in a child is not a death sentence. There is no need to panic when you hear it. Sometimes, healing from it is a matter of time and growing up.

Most parental fears are associated with ignorance of the nature of this cardiac anomaly. Let us consider in detail what this anomaly is, how it is diagnosed and treated.

What is a patent foramen ovale in the heart?

While in a state of intrauterine development, the child does not breathe, his lungs do not take part in the blood circulation.

Oxygen and necessary for the body fetal substances are distributed to the organs in another way, called choreal:

1. from the placenta arterial blood enters through a vein located in the umbilical cord in the so-called. Arantium duct,
2. passes into the inferior vena cava, where it mixes with venous blood;
3. then the blood through this vessel and the superior vena cava enters the right atrium;
4. then, through the open foramen ovale in the interatrial septum, with the help of a valve-shaped fold, blood enters the left atrium;
5. further - into the left ventricle and aorta.

Thus, the open oval window plays one of the main roles in this period of development of the cardiovascular system: with its help, blood spreads into the brain and spinal cord, bypassing the lungs that are not yet functioning.

After the birth of the child, when starting work respiratory system, choreal blood circulation becomes unclaimed. Due to the increasing pressure in the left atrium, due to the onset of lung function, the oval window is blocked by a valve-shaped fold: it is mechanically pressed against the interatrial septum, blocking the oval window.

If this position is maintained after a period of time from 2 months to 5 years, the hole becomes overgrown with connective tissue and only a small hole remains, normally the diameter of a catheter.

In some cases, the process of tissue fusion is disrupted and the window does not close completely.

Reasons why the oval window does not close

Why doesn't the oval window close around its entire perimeter? This occurs if the valve size does not correspond to the metric parameters of a given hole.

This disruption of the development of the cardiovascular system occurs for a number of reasons, among which experts note the following:

• smoking and drinking chemical substances mother during pregnancy,
• underdevelopment of the valve due to premature birth of a child,
• genetic predisposition,
• connective dysplasia.

When is a symptom normal, when is it a pathology?

If the oval window does not heal completely and remains open, there may be episodic disorders blood circulation For any disturbance in the pressure in the heart with increased tension in the abdominal muscles (during crying, coughing or active play) the valve opens, allowing blood to flow directly into the left atrium. This process occurs invisibly and, as a rule, has no external manifestations.

A patent foramen ovale is not a heart defect. If it is present, deviations in the structure of the cardiac system from physiological norm, which do not pose a threat to the patient’s life. Experts regard it as MARS - a minor anomaly in the development of the heart and do not classify it as a pathology.

This deviation occurs quite often: in children under 5 years of age it occurs in 50% of cases of complaints of cardiac disorders, in adults - up to 25%.

The results of a study of 1100 hearts conducted in 1930, organized by T. Thompson and W. Evans, are surprising. According to them, this anomaly is characteristic of 35% of those examined. Of these, 6% of the hearts had a diameter of the open foramen ovale measuring up to 7 cm (3% were newborns up to 2 months old, the remaining 3% belonged to adult subjects).

The diameter of the patent foramen ovale can range from 3 mm to 19 mm, depending on the age of the person and the size of his heart. But this anomaly is not classified as a pathology on this basis.

The main indicators for establishing pathological processes are dangerous symptoms in the form of causeless fainting and heart failure, as well as an increase in pulmonary blood flow.

Features of blood circulation with a functioning open oval window

The oval window is located on the inner left wall of the right atrium, has the shape of a slit and an average diameter of 4.5 cm. Due to its valve structure, the open oval window ensures the direction of blood flow only from the small hemodynamic circle to the large one; the septum prevents the back shunt of blood from left to right.

Direct discharges of blood into the left atrium are not constant and occur in the form of relapses and isolated cases.

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This window symptom usually does not cause inconvenience to its bearer in childhood; complications can occur only in adulthood. In a calm state of the body, it does not lead to circulatory disorders. The release of blood from one atrial chamber to another is possible only with increased physical activity on the abdominal muscles.

• violation of the pressure of the valve closing the window, when it is more slow growth, regarding the whole heart;
• concomitant diseases characterized by increased pressure in the right atrium. In this case, the pressure on the valve from the side of this atrium becomes higher than from the part of the left one, the pressure on the valve weakens and the window opens mechanically.

Diseases that can lead to increased right atrial pressure include the following:

1. chronic lung diseases,
2. leg vein diseases,
3. combined heart pathology.

In addition, this phenomenon is possible during pregnancy and childbirth.

In such cases, constant medical supervision is necessary.

In other situations, an open oval window is harmless and, surprisingly, sometimes even necessary.

So, in cases of primary pulmonary hypertension, characterized by increased pressure in the lungs, part of the blood from the pulmonary circle is thrown into the left atrium. This unloads the blood vessels and alleviates the symptoms of the disease: shortness of breath, cough, weakness, fainting. Sometimes opening the oval window saves life in this disease.

Symptoms and diagnosis

In children, the opening of the oval window often has no manifestations, is an asymptomatic deviation from the norm and proceeds latently.

But in some cases, this cardiac anomaly is accompanied by scant symptoms and manifests itself in the following complaints:

In some cases, frequent migraines and pastoral hypoxemia syndrome are observed (the appearance of shortness of breath in a standing position, and its disappearance when moving to a horizontal position).

Detection of such symptoms in a child is the basis for contacting a cardiologist to establish an accurate diagnosis.

Diagnosis of an open oval window is carried out in several ways:

1. Visual inspection. The method is ineffective because external manifestations A minor anomaly can only be noticed by an experienced physician. This method serves only to establish a suspicion of deviation, taking into account complaints about the above symptoms. A blood shunt, manifested as a heart murmur, is determined by auscultation. Find out more about
2. EchoCG. This method is used to diagnose an open window not only when a specialist suspects an anomaly, but also often completely by accident during general examinations. This is a common case when the opening of the oval window is latent.
3. ECG is performed in two positions of the body: in a calm state and after performing physical exercises.
4. Radiography. With the help of this instrumental research determine cardiac dysfunction associated with increased blood pressure in the right atrial chamber, as a consequence the possibility of the oval window starting to function.
5. Transthoracic two-dimensional echocardiography. Used to diagnose a patent foramen ovale in newborns. Helps visualize the movement of the valve leaflets and determine the absence of concomitant cardiac pathologies. The method allows not only to determine the presence of an open foramen ovale, but also to determine the speed and volume of blood flow during a shunt from one atrium to another.
6. Transnutritive echocardiography. Used to diagnose a functioning window in older children and adolescents. The method is carried out by immersing the probe into the esophagus, in the closest position to the heart, in order to visualize it as accurately as possible.
   To improve the diagnosis of an open window, bubble contrast is used: determination of the presence of bubbles in the left atrium after their appearance in the right in a relatively short period of time, indicating a blood shunt between the atria.
7. Probing of the heart. The method is considered the most accurate, but also the most aggressive. It is used before surgery in specialized centers and involves advancing the probe through the artery to the heart directly for detailed visualization and diagnosis.
8. allows you to determine the exact boundaries of the open window and its size. Suitable for both newborns and older children.

Treatment of an open oval window in the heart

If the functioning of the open oval window does not manifest itself in the above symptoms, then it does not require treatment and a minor anomaly is not considered a deviation from the norm. Treatment with anticoagulants and antiplatelet agents is prescribed only after a transient ischemic attack or to prevent thromboembolic complications in adult patients.

Among the treatment methods pathological cases surgical intervention is also included.

The indicator for prescribing the operation is the volume of shunted blood and its Negative influence on the functioning of the cardiovascular system - if the volume is small and no complications are observed, heart surgery is not needed.

If blood discharges from the left atrium to the right are regular, then experts determine the patient’s condition as pathological.

In such cases, indications for surgical intervention are the following reasons:

• heart failure,
• pulmonary hypertension,
• frequent pneumonia with complications,
• physical retardation of the child.

Most often, in such cases, a low-traumatic operation is prescribed - x-ray endovascular occlusion. It is performed by inserting an occluder through a vein, which opens into the heart and covers the open window like a patch. To introduce the instrument into the body, the pelvic arteries are used, elbow joint or neck, after performing a puncture in them.

The advancement of the occluder to the open foramen ovale is carefully monitored radiographically and echocardioscopically.

This method allows you to perform rational intervention without the use of widely used techniques:

• opening the chest,
• temporary stop of heartbeat,
• artificial respiration and blood circulation,
• without the introduction of general deep anesthesia.

After such an operation, the child returns to the normal rhythm of life. There are no restrictions or contraindications.

Complications, consequences

1. The main danger with an open foramen ovale can be paradoxical embolism. This phenomenon threatens the patient when concomitant diseases veins: the detached thrombus passes through the open window into big circle hemodynamics and blockage of an artery important for life may occur, which will certainly lead to death.
   The disease is accompanied by neuralgic disorders that appear unexpectedly.
2. Septic endocarditis is also dangerous, often found in patients with a functioning oval window.
3. TIA - transient ischemic attack. This is a temporary disturbance of blood circulation in the cerebral center. TIA is accompanied by neuralgic disorders that resolve within 24 hours.
4. There is danger cerebrovascular accidents.

Parents whose children have been diagnosed with a patent foramen ovale should follow these recommendations:

• Even in the absence of pronounced symptoms It is necessary to register the child with a cardiologist. The doctor should monitor the child regularly.
• Patent foramen ovale in the heart and sports accompanied by heavy loads are incompatible. Physical exercise should not contain strength exercises and excessive tension of the abdominal muscles. The child should be protected from running, squats, jumping and anything that could provoke a shunt.
• You should properly organize your daily routine to balance the child’s periods of activity and rest. You need to include naps in your schedule.
• Every 2 hours you need to do a little exercise, stretch your leg muscles to prevent the possibility of developing vein diseases in the future. Pay attention to the positions in which the child sits. Get him used to sitting with correct position legs: they should not be tucked and folded crosswise.
• The best way to prevent in the future of a stroke - lead an active lifestyle to prevent blood stagnation in the lower extremities and prevent venous diseases.
• Experts recommend hardening and restorative procedures.
• Children with this diagnosis An annual holiday at a resort and regular walks in the fresh air are required.
• Make sure you drink enough, which the child should consume every day.

Do not let your child notice your concerns about his health - this can lead to panic and increased nervousness. This will not help improve his condition.

All questions that relate to the direct structure of the child’s heart raise many questions and fears in all parents, since this organ is the basis of life, along with the brain, and if it even contains small defect, this really scares mom and dad. After an ultrasound of the heart, the doctor suddenly writes on the chart “an open foramen ovale in the heart,” and all parents think that the baby has a heart defect, they panic too much and start running to specialists. Today, approximately 70% of children have such a conclusion in the first anxious month of life, but what kind of oval window is this, and why should it be open?

Baby's blood circulation

During pregnancy, cardiac and vascular system develop early, but the heart is formed in the body already at three weeks. Of course, it is still being formed and developing, but it copes with its main functions. During the prenatal tender period, the baby's blood circulation is special - the lungs are completely turned off. In order to optimally provide the growing body and brain with oxygen, a special structure of the heart is needed.

Blood enters the small heart in a roundabout way, bypassing the pulmonary circle, so there are several additional holes in children's heart- Botal duct, as well as a small open oval window. Why is it open? Through the duct, the blood enters directly into the heart, bypasses the pulmonary aorta and blood vessels, and through the oval window it moves from the right to the left atrium. If this hole, thought out by nature, had not been provided and it had not been open even by some 2-3 mm, the right parts of the heart would have been overloaded and the child would not have been able to live in the womb.

At birth, a child’s blood circulation changes dramatically; the ductus ductus, as well as the open foramen ovale, lose their original relevance and therefore must close. This occurs due to the opening of the lungs and breathing. Due to changes in the left atrium, the patent foramen ovale is closed by a valve.

This usually occurs in newborns on the first day of life. The oval window closes, and a full-fledged permanent interatrial septum begins to form. Of course, this process can take quite a long time, but more often the open foramen ovale in tiny newborns closes immediately.

Oval open window: reasons for formation

Underdevelopment of the valve, as well as an open oval window, occurs in premature newborns. The causes of this phenomenon are considered to be a noticeable disturbance throughout pregnancy - threats of miscarriage, fetal hypoxia or toxicosis. Also, the risk of getting a patent oval window is increased in women who smoke and drink alcohol while carrying a child. Also, the window may be open due to unfavorable ecology, stress during pregnancy, or the influence of heredity.

As a result of all the indicated processes, the normal natural development of the valve in the area of ​​the oval window itself is disrupted; it simply does not have time to grow to the required size.

However, a patent foramen ovale can also occur with more acute and serious problems rather than a simple functional defect. Sometimes, with ailments that load the right chambers of the heart, the window may not close to alleviate the child’s condition.

Manifestation of such a state

With a small defect size of 2-3 mm, this is ordinary child, there are no vices in this situation, therefore there will be no manifestations. A patent foramen ovale is detected by ultrasound examination, which is required for all children under one year of age. However, if the defect is significantly larger than 2-3 mm, there are certain signs that help the doctor detect the problem:

• Cyanosis of the nasolabial triangle or lips in a child with strong crying, screaming, or activity.
• Frequent diseases include colds, pneumonia and bronchitis.
• A patent foramen ovale is immediately manifested by listening to a heart murmur.
• Certain slowdowns in the pace of physical or psychological development may certainly indicate that the oval window is open even by 2-3 mm.
• To show that the oval window is open, there may be attacks of loss of consciousness, manifestation different symptoms disorders of all cerebral circulation.
• Inability to perform increased physical activity, fatigue, and a feeling of shortness of breath also indicate that the window is not normal.

The last three symptoms occur when the defect significantly exceeds 2-3 mm. If the doctor suspects your child has a patent foramen ovale, he will refer him for a consultation with an experienced cardiologist and an ultrasound scan. It is there that they will verify its size: 2-3 mm, when anxiety is unnecessary, or more, when it is necessary to correct the disease with treatment.

Oval open window of a child: what to do?

If an oval open window has been discovered in a baby, you need to decide further actions parents, cardiologist and pediatrician. If the window is open only 2-3 mm, it should not cause concern, since such a hole quickly closes in a couple of months. You just need to see a doctor and sometimes undergo an ultrasound.

If the window is open significantly more than 2-3 mm, you will need to go for an ultrasound every six months to determine the size of the defect. If the open hole becomes smaller, the specialist will suggest waiting and doing nothing - there is a high probability of spontaneous healing of this defect.

If open oval window more than 7 and even 10 mm, serious abnormalities that are typical of heart defects may appear. Such a hole will be called gaping. The child needs to be consulted by a good cardiac surgeon and the issue of urgent surgery with a certain correction of the septum must be decided.

The greatest danger of the disease is the possibility of active development of acute paradoxical embolism, which affects the vessels of the head. But this happens quite rarely.

All photographic materials are taken from the site Google.Images.ru

Open oval window (hole) in the heart: causes, closure, prognosis

According to statistical data, the prevalence of patent foramen ovale (PFO) in the heart differs in different age categories. For example, in children under one year of age this is considered a normal variant, since according to ultrasound, an oval hole is detected in 40% of infants. In adults, this anomaly occurs in 3.65% of the population. However, in people with multiple heart defects, a gaping oval window is recorded in 8.9% of cases.

What is the “oval window” in the heart?

The oval window is an opening with a valve flap located in the septum between the right and left atria. The most important difference between this anomaly is that the oval window is equipped with a valve and is localized directly in the area of ​​the oval fossa of the heart, while with ASD, part of the septum is missing.

location of the oval window in the heart

Blood circulation in the fetus and the role of the oval window

Blood circulation in a fetus occurs differently than in an adult. During the prenatal period, the baby has so-called “fetal” (fruit) structures functioning in cardiovascular system. These include the oval window, the aortic and venous ducts. All these structures are necessary for one simple reason: The fetus does not breathe air during pregnancy, which means its lungs do not participate in the process of saturating the blood with oxygen.

blood circulation and structure of the fetal heart

But first things first:

Immediately after birth, when the newborn takes his first breath, the pressure in pulmonary vessels increases. As a result, the main role of the oval window to dump blood into the left half of the heart is leveled out.

During the first year of life, as a rule, the valve completely independently fuses with the walls of the hole. However, this does not mean at all that an unclosed foramen ovale after 1 year of a child’s life is considered a pathology. It has been established that the communication between the atria can close later. There are often cases where this process is completed only by the age of 5 years.

Video: anatomy of the oval window in the heart of the fetus and newborn

The oval window does not close on its own, what are the reasons?

The main cause of this pathology is a genetic factor. It has been proven that patent valve disease persists in people with a predisposition to connective tissue dysplasia, which is inherited. It is for this reason that in this category of patients other signs of decreased strength and collagen formation can be found in connective tissue(pathological joint mobility, decreased skin elasticity, prolapse (“sagging”) of the heart valves).

However, other factors also influence non-closure of the oval window:

1. Unfavorable environment;
2. Taking some during pregnancy medicines. More often this pathology caused by non-steroidal anti-inflammatory drugs (NSAIDs). It has been proven that these drugs cause a decrease in the level of prostaglandins in the blood, which are responsible for the closure of the oval window. Moreover, taking NSAIDs is dangerous in late gestation, which is the reason why the oval window did not close;
3. Drinking alcohol and smoking during pregnancy;
4. Premature birth (this pathology is more often diagnosed in premature babies).

Types of oval window according to the degree of nonfusion

• If the size of the hole does not exceed 5-7 mm, then usually in such a situation the detection of an oval window is a finding during echocardiography. It is traditionally believed that the valve valve protects against backflow of blood. That is why this option is hemodynamically insignificant and appears only during high physical activity.
• Sometimes there are cases when the oval window is so large (exceeds 7-10 mm) that the size of the valve is not enough to cover this hole. In such situations, it is customary to talk about a “gaping” oval window, which, according to clinical signs, may be practically no different from an ASD. Therefore, in these situations the border is very arbitrary. However, if we look at it from an anatomical point of view, then with an ASD there is no valve flap.

How does the disease manifest?

With a small size of the oval window, external manifestations may be absent. Therefore, the attending physician can judge the severity of the nonunion.

For children infancy with an open oval window it is characteristic:

Adults with pathology may also experience bluish lips with:

1. Physical activity that is fraught with an increase in pressure in the pulmonary vessels (long-term breath holding, swimming, diving);
2. Heavy physical work (weightlifting, acrobatic gymnastics);
3. For lung diseases ( bronchial asthma, cystic fibrosis, emphysema, pulmonary atelectasis, pneumonia, with hacking cough);
4. If there are others.

With a pronounced oval hole (more than 7-10 mm), the external manifestations of the disease are as follows:

• Frequent fainting;
• The appearance of bluish skin even with moderate physical activity;
• Weakness;
• Dizziness;
• Child's delay in physical development.

Diagnostic methods

It is the “gold” standard and the most informative method for diagnosing this pathology. The following signs are usually detected:

1. Unlike ASD, when the foramen ovale is open, it is not the absence of part of the septum that is revealed, but only its wedge-shaped thinning is visible.
2. Thanks to color Doppler ultrasound, you can see “swirls” of blood flow in the oval window area, as well as a slight discharge of blood from the right atrium to the left.
3. With a small size of the foramen ovale, there are no signs of enlargement of the atrium wall, as is typical for ASD.

The most informative is ultrasonography heart test, conducted not through the chest, but so-called transesophageal echocardiography. At this study An ultrasound probe is inserted into the esophagus, as a result of which all the structures of the heart are visible much better. This is explained by the anatomical proximity of the esophagus and the heart muscle. The use of this method is especially relevant in case of obesity of the patient, when visualization anatomical structures difficult.

transesophageal echocardiography is the most informative method identifying LLC

In addition to cardiac ultrasound, other diagnostic methods can be used:

• An electrocardiogram may show signs of bundle branch block, as well as conduction disturbances in the atria.
• With a large foramen ovale, changes in the chest x-ray are possible (slight enlargement of the atria).

How dangerous is the pathology?

1. People at risk should avoid heavy physical activity, as well as choosing professions such as scuba diver, diver, and diver. It has been proven that in the presence of this pathology, the likelihood of developing it is 5 times greater than among a healthy population.
2. In addition, this category of people may develop such a phenomenon as. This phenomenon perhaps in people with a tendency to in blood vessels lower limbs. A thrombus that breaks away from the wall of a vessel can enter the systemic circulation through the foramen ovale. As a result, blockage of blood vessels in the brain, heart, kidneys and other organs is possible. If the blood clot is large, it can cause death.
3. It is important to remember that people with a patent oval window are more likely to develop a disease such as. This is due to the fact that microthrombi can form on the walls of the valve flap.

Methods of treatment and prevention of complications

With a favorable course of the pathology and with a small size of the oval window according to ultrasound of the heart specific treatment not required. However, this category of people should register with a cardiologist and undergo a heart examination once a year.

• Considering the likelihood of developing thromboembolism, patients at risk should also examine the veins of the lower extremities (with an assessment of the patency of the veins, the presence or absence of blood clots in the lumen of the vessels).
• When carrying out any surgical interventions in patients with an open foramen ovale, it is necessary to prevent thromboembolism, namely: elastic bandaging of the lower extremities (wearing compression hosiery), as well as taking anticoagulants several hours before surgery. (You need to know about the presence of a defect and warn your doctor).
• It is important to observe a work and rest schedule, as well as dose physical activity.
• Sanatorium treatment (electrophoresis with magnesium sulfate has a positive effect).

In the presence of blood clots in the lower extremities, these patients require constant monitoring of the blood coagulation system (indicators such as international normalized ratio, activated partial thrombin time, prothrombin index). Also in such a situation, observation by a hematologist and phlebologist is mandatory.

Sometimes patients with a patent foramen ovale show signs of cardiac conduction disturbances according to ECG data, as well as unstable blood pressure. In such situations, you can take drugs that improve metabolic processes in cardiac muscle tissue:

1. Medicines containing magnesium (“Magne-B6”, “Magnerot”);
2. Drugs that improve the conductivity of nerve impulses (“Panangin”, “Carnitine”, B vitamins);
3. Drugs that activate bioenergetic processes in the heart (“Coenzyme”).

Surgery

Surgery may be required if the oval window has a large diameter with blood flowing into the left atrium.

At present wide use received endovascular surgery.

The essence of the intervention is that a thin catheter is installed through the femoral vein, which is passed through the vascular network to the right atrium. The movement of the catheter is monitored using an X-ray machine, as well as an ultrasound sensor installed through the esophagus. When the area of ​​the oval window is reached, so-called occluders (or grafts) are inserted through the catheter, which are a “patch” that covers the gaping hole. The only drawback of the method is that occluders can cause local inflammatory reaction in heart tissue.

endovascular closure of the oval window in the heart

In this regard, the BioStar absorbable patch has recently been used. It is passed through a catheter and opens like an “umbrella” in the atrium cavity. A special feature of the patch is its ability to cause tissue regeneration. After attaching this patch to the area of ​​the hole in the septum, it dissolves within 30 days, and the oval window is replaced by the body’s own tissues. This technique is highly effective and has already become widespread.

Disease prognosis

For oval windows less than 5 mm, the prognosis is usually favorable. However, as mentioned above, a large diameter of the oval hole is subject to surgical correction.

Pregnancy and childbirth in women with the defect

During pregnancy, the load on the heart increases significantly. This happens for several reasons:

• The volume of circulating blood increases, by the end of pregnancy it exceeds baseline by 40%;
• The growing uterus begins to occupy most abdominal cavity and closer to childbirth it puts a lot of pressure on the diaphragm. As a result, the woman experiences shortness of breath.
• During pregnancy, the so-called “third circle of blood circulation” appears—placental-uterine.

All these factors contribute to the fact that the heart begins to beat faster, and the blood pressure also increases. pulmonary artery. Because of this, women with this heart abnormality may experience adverse complications. Therefore, pregnant women with this pathology are subject to observation by a cardiologist.

Are young people with a patent foramen ovale accepted into the army?

Despite the fact that in most cases this cardiac anomaly occurs without any clinical symptoms, young people with a patent foramen ovale belong to category B with limited suitability for military service. This is primarily due to the fact that with high physical activity there is a high probability of developing complications.

conclusions

Due to the development additional methods Research and detection of such anomalies as a patent foramen ovale has increased significantly.

In most cases, this pathology is discovered as an incidental finding during examination. However, patients must be informed that they have an open oval window, and they also need to know about certain restrictions in physical work, as well as in choosing a profession.

The presence of the foramen ovale deserves special attention large sizes, which is essentially an analogue of an atrial septal defect. In this situation, surgical correction is recommended for patients.

What is a patent foramen ovale?

A patent foramen ovale (Figure 1) is a small opening between the right and left atria that normally functions in every fetus. This structure acts as a valve that directs blood from lower half the fetal body into the left chambers of the heart, bypassing the non-functioning lungs. As the lungs expand with the baby's first breaths, the need for this structure disappears, since now all the blood from the body passes through the lungs and only then enters the left atrium. The pressure in the left atrium gradually increases and several months after birth exceeds the pressure in the right atrium, which contributes to the closure of the oval window in most people.

However, the oval window does not heal and remains open in approximately 25% of healthy adults.

Symptoms

A patent oval window is individual feature and does not manifest itself clinically. The oval window is not considered a heart defect. Patients with a patent foramen ovale may be treated familiar image life and physical activity.

Patent foramen ovale and stroke

Under certain conditions, when the pressure in the right atrium again begins to exceed the pressure in the left atrium, the oval window again begins to act as a valve, directing blood from the lower half of the body to the left chambers of the heart. If there is stagnation of blood in the venous system (for example, in the veins of the lower extremities or pelvis), blood clots form there. The latter, together with the blood, can pass through the oval window into the left chambers of the heart, then into the brain and cause a stroke (Video 1).

A patent foramen ovale is found in 25% of adults under the age of 55 who have had a STROKE. In most cases, a patent foramen ovale is often combined with thrombosis of the veins of the lower extremities and in a sedentary manner life.

Diagnostics

All young people who have suffered a stroke should undergo routine transthoracic and transesophageal ultrasound of the heart and Doppler craniography of cerebral vessels. An ultrasound of the heart confirms or excludes the presence of an oval window, its anatomy (the presence of an aneurysm of the interatrial septum), and shows, using various tests, the direction of blood flow at the level of the oval window.

If, during echocardiography, when the patient strains (Valsalva maneuver), the direction of blood flow from the right atrium to the left is observed, this confirms the fact that the cause of the stroke was a patent foramen ovale.

Ultrasound Dopplerography of the vessels of the head (Doppler craniography) confirms or excludes the entry of small blood clots from the veins of the lower extremities into the vessels of the brain through the oval window.

The presence of an aneurysm of the interatrial septum in combination with a patent foramen ovale increases the likelihood of developing a stroke, since the aneurysm contributes to greater mobility of the septum, which means large quantity blood clots will go through the oval window into the vessels of the brain.

Should a patent foramen ovale be closed?

If the foramen ovale is found by chance during a routine cardiac ultrasound, there is no need to close it. The oval window does not lead to an increase in heart size. It is possible to distinguish a foramen ovale from a small atrial septal defect only with the help of transesophageal ultrasound.

THE OVAL WINDOW SHOULD BE CLOSURED ONLY IF THE PERSON HAS SUFFERED A STROKE. It is closed if the presence of a right-to-left direction of blood flow is confirmed during the Valsalva maneuver.

The oval window is closed endovascularly using a special device - an occluder (Fig. 2, 3).

The technique and device are similar to closure of an atrial septal defect (Video 2).

Closing the patent foramen ovale in young people who have had a stroke SIGNIFICANTLY REDUCES THE RISK OF REPEATED STROKES (Video 3).

Lifestyle in patients with a patent oval window.

If you are a driver and you know that you have a patent foramen ovale, it is recommended that you stop every 2 hours for a short walk. An active lifestyle reduces the risk of blood stagnation and thrombus formation in the veins of the lower extremities, and therefore reduces the risk of stroke in patients with a patent foramen ovale.

Video 1: A blood clot travels from the right side of the heart to the left and causes a stroke

Video 2: In this colorful animation you can see how the LLC is closed with an occluder.

Video 3: LLC closed with an occluder (X-ray video).

How is the treatment done?

Myths and reality about endovascular surgery
congenital heart defects

Currently, X-ray endovascular surgery is attracting more and more attention from almost all media, including print media, the Internet and television. Every day we are confronted with a massive flow of information on various aspects of this modern field of medicine. Every day they write and talk about it, but, unfortunately, not everything and not always objectively. There are many erroneous statements, rumors or even myths that need to be corrected with factual information.

Myth 1. This is a very new, almost experimental field of cardiovascular surgery.

This is wrong! Endovascular surgery has rich history and has long been widely used in medical practice. Cardiac catheterization was first performed in 1929 by R. Forsmann (Germany), for which he received the Nobel Prize in 1956. In 1964, the first balloon angioplasty was performed and since then endovascular surgery has ceased to be a purely diagnostic area of ​​medicine. Further discoveries and inventions of devices followed one after another: 1975 - spirals, 1976 - occluders, 1979 - emboli, 1986 - coronary stents, 1994 - stents for large vessels, 2005 - endovascular heart valves! To date, all of the above devices have evolved to more advanced analogues. The most common occluder in the world has become the Amplatzer occluder - more than half a million implantations since 1995. At the Amosov Institute, Amplatzer occluders have been installing their analogues since 2003. The trend in the world is that diagnostics have moved from the cath lab to echocardiography rooms and computed tomography, and the treatment of heart defects has moved from the operating room to the cath lab. In developed countries of the world (USA, Canada, Australia, Europe), ductus botellus, septal defects, and coarctation of the aorta are practically not operated on surgically. Our institute takes into account all modern global trends when treating patients.

Myth 2. Devices used to treat defects (occluders, coils, stents) are foreign bodies and may be rejected.

All these devices are made of modern high-tech biocompatible materials that do not cause rejection reactions. Six months after the operation, these devices are completely covered with endothelium (sprout with their own cells) and do not differ from inner surface hearts. All devices are non-magnetic; after their implantation, the patient can undergo an MRI. They don't beep at airport metal detectors, mall etc.

Myth 3. Occluders move (fly away).

Indeed, in our and world practice such cases occur, but their frequency is about 1%. The complication is unpleasant, but not critical. There has not been a single case in the world when a displaced occluder would have led to fatal outcome. As a rule, such an occluder is removed endovascularly and reinstalled or replaced with a larger one. The greatest number of displacements occurs in the first hours or days after surgery, when the patient is still in the clinic. Further, the probability of this decreases sharply; distant displacements are casuistic.

Myth 4: Atrial septal defects with missing or thinned edges are not amenable to endovascular closure.

The absence of the aortic edge of the septum is not a contraindication to occluder placement. The same applies to a thinned or aneurysmal septum. Remember that conventional (transthoracic) echocardiography does not provide a complete picture of the defect. Even if a diagnosis of absence of a margin is made, this does not mean that it is not there. The clear anatomy of the defect can only be judged after transesophageal echocardiography, which is the gold standard for selecting patients for endovascular treatment.

Myth 5. Occluders require replacement over time.

The device does not need to be replaced either as the patient grows or over time. The occluder grows into the septum within 6 months and creates the basis for its further growth. In the case of vascular stenting, it is possible to endovascularly increase the lumen of the stent with vessel growth without replacing the implant.

Myth 6. It's expensive...

Endovascular surgery is high technology, which really costs more normal operations. In some cases, the patient buys the device for implantation, but there is a waiting list for free implants, which are purchased by the institute. In addition, we cooperate with numerous relief funds that, in a relatively short time, raise funds to purchase devices for children. In most cases, there is no urgency in the operation, and patients have enough time to raise funds for the implant, wait their turn, or find a sponsor. Therefore, if a patient wishes to undergo endovascular surgery, there are currently no barriers to this.

FAQ

The average hospital stay is 3-4 days. As a rule, on the morning of admission you undergo an examination, including clinical and biochemical analysis blood (you need to arrive on an empty stomach), do X-ray, ECG, ultrasound examination of the heart and consultation with a cardiologist and cardiac surgeon. If all indicators are normal, the next day an operation is performed to eliminate the defect. On the third day, we conduct control tests and discharge you.

To be admitted to our hospital, you will need a passport or a child’s birth certificate.

If the patient childhood, you need a certificate of sanitary and epidemiological conditions (stating that the child has not recently had contact with infected patients), which you will receive at the clinic at your place of residence.

It is advisable to have previous advisory reports, an ECG and a chest x-ray with you.

A referral from a local cardiologist is NOT REQUIRED. You can come for a consultation and subsequent treatment by self-referral. If you are over 30 years old or have experienced interruptions in your heart function, it is advisable to conduct Holter monitoring at your place of residence. Such a study can be carried out here, but this will increase your time in hospital by 1-2 days.

If you are suffering chronic gastritis, peptic ulcer stomach or duodenum it is necessary to do a fibrogastroduodenoscopy. If the disease is confirmed, you need to undergo treatment at your place of residence. Such a study can be carried out here, but this will increase your time in hospital by 1-2 days in the absence of ulcers and erosions.

All adult patients undergo surgery under local anesthesia. The patient can observe the progress of the operation and communicate with the staff. An exception is patients with an atrial septal defect, who require transesophageal ultrasound guidance during surgery and, for patient comfort, the operation is performed in a state of medicated sleep. All endovascular operations in children and hypochondriac patients are performed under general anesthesia.

It is necessary to limit vigorous physical activity for 6 months. Prevention is necessary respiratory infections, tonsillitis, caries. If the disease begins to develop, the treatment regimen should include antibacterial drugs, after consulting a doctor. During the first month after surgery, it is also necessary to limit sexual activity.