Closed foramen ovale in the heart in children. Causes, symptoms and treatment of an open oval window in an infant

Our article is devoted to this common pathology. This material will reveal to you the essence of the problem of a functioning oval window.

In 1930, scientists studied about 1,000 children's hearts, and as a result, about 35% of the subjects had a patent foramen ovale (PFO). Nowadays, the frequency of this phenomenon reaches 40% in the pediatric population.

Why does the fetus need an oval window?

In the womb of the mother, the child does not breathe in the literal sense of the word, since the lungs cannot function, they resemble a deflated balloon. A patent foramen ovale in newborns is a small opening between the atria. Through the oval window, blood from the veins flows into the only big circle blood circulation of the fetus.

After birth, the baby takes his first breath, the lungs begin their work. Under the influence of the pressure difference, the open oval window is closed by a valve. But such a valve may be too small to completely tighten the hole.

A functioning foramen ovale is an anomaly of the heart, and in no way a defect.

There is no exact cause for this pathology.

Highlight Some of the most common factors.

1. In almost all premature and immature newborns, the window remains open.
2. Smoking, maternal substance abuse.
3. Intrauterine fetal hypoxia.
4. Prolonged labor, asphyxia of the baby during childbirth.
5. Adverse environmental factors.
6. Mother's stress.
7. Genetic predisposition.
8. Congenital heart defects.
9. Occupational exposure to toxic substances in the mother.

Open oval window in children and its symptoms

In most cases, such children do not complain.

Therefore, it is very important for mothers to be attentive and monitor the slightest deviations in the behavior of their babies.

What can you notice?

1. The appearance of blueness around the mouth of a newborn. This cyanosis appears after crying, screaming, sucking, or bathing.
2. In older children, tolerance (resistance) to physical activity decreases. The child rests and sits down after regular outdoor games.
3. The appearance of shortness of breath. In general, a child should normally be able to easily climb to the 4th floor without any signs of shortness of breath.
4. Frequent colds in infants, namely: bronchitis, pneumonia.
5. Doctors listen for a heart murmur.

PERSONAL EXPERIENCE. The child is 10 days old; during bathing, the mother notes the blueness of the nasolabial triangle. The child was born full-term, weighing 3500. The mother admitted that she smoked during pregnancy. On examination, a murmur was noted at the apex of the heart. The baby was sent for an ultrasound. As a result, an open oval window of 3.6 mm was revealed. The child has been registered.

Ultrasound of the heart is of primary clinical significance. The doctor clearly sees a small hole in the projection of the left atrium, as well as the direction of blood flow.

If you hear a heart murmur, your pediatrician will definitely refer your baby to this type research.

According to new standards, at 1 month all newborns must undergo ultrasound screening, including the heart.

As a rule, there are no pathological changes on the ECG with LLC.

In 50% of children, the oval window functions for up to a year and then closes on its own; in 25%, fusion occurs by the fifth year of life. In 8% of the adult population, the window remains unlocked.

What to do if the window has not closed after 5 years? Basically, nothing. The open foramen ovale in a newborn is too small in size to ensure overload of the atria with the development of heart failure. Therefore, it is necessary to dynamically monitor the baby, undergo an annual heart ultrasound and be examined by a pediatric cardiologist.

PERSONAL EXPERIENCE. At the reception there was a 13-year-old boy. For 4 years the child has been involved in active sports – rowing. By chance, during a medical examination, an ultrasound of the heart was performed, where an oval window measuring 4 mm was first discovered. At the same time, the child did not show any complaints throughout his 13 years and coped well with physical activity. He even took first place in competitions.

If a child has complaints, he is prescribed drug therapy in the form of cardiotrophic drugs and nootropics - Magnelis, Kudesan, Piracetam.

These drugs improve myocardial nutrition and exercise tolerance.

Recently, it has become reliable that the drug levocarnitine (Elkar) promotes rapid closure of the oval window if taken for 2 months in a course 3 times a year. True, it is not entirely clear what this is connected with. From personal experience, I can say that I did not see a clear connection between Elkar’s appointment and the closure of the LLC.

But it still happens that the oval window can lead to poor circulation and heart failure. In pediatric practice, this is rare, in most cases it occurs by the age of 30-40. Then the issue of surgical intervention to close this hole is decided. A small patch is applied endovascularly (that is, using a catheter) through the femoral vein.

As for sports and a functioning oval window, in the absence of complaints and good performance Heart ultrasound can be performed in any sport.

Complications

They are quite rare. Associated with embolism and impaired blood flow. These are heart attacks, strokes and kidney infarctions.

These complications can already occur in adults. And such a patient should always warn the doctor that he has a functioning foramen ovale.

Minor heart anomalies for the most part do not harm the health of children. Some famous athletes have this pathology and become Olympic champions. Many doctors consider LLC normal. But it should be remembered that annual supervision by a specialist is necessary.

A patent foramen ovale is a pathology of the heart, namely the presence of a gap in the septum between the left and right atria, which is necessary for the baby’s intrauterine life. After birth, this window should close completely with a valve and become overgrown.

As practice shows, this pathology is present in ½ of the population who live in a normal way life and are not aware of the presence of the disease.

Oval window - classification of cardiac pathology

Pathology can be classified according to dimensions, which are measured in millimeters:

1. With sizes ranging from 5 to 7 mm, the diagnosis may sound hemodynamically insignificant. An open window can manifest itself in this case only during strong physical exertion.
2. If the size of the oval window ranges from 7 to 10 millimeters, then the diagnosis may sound like a “gaping oval window” and symptomatically is not much different from birth defect heart (atrial septal defect).

Reasons for a window not closing

There are a number of reasons that can lead to the development of this pathology:

• hereditary factor, most often observed in the first line of kinship;
• bad habits of the mother during pregnancy (alcohol and smoking);
• presence of bad environmental factor during pregnancy;
• lack of healthy nutrition for the mother during pregnancy;
• a woman expecting a child is in constant stress and depression;
• Availability toxic poisoning during pregnancy (including medications);
• also the presence of early delivery; in most cases, it is premature babies who suffer from this pathology.

How should it close?

By all medical indications Closing the oval window with a special valve during the normal development of the baby occurs in the first seconds of his independent life, at the first breath.

With an increase in pressure in the blood vessels of the lungs, the functionality of the oval window becomes unclaimed.

The valve should completely adhere to the septum by the end of the baby's first year of life. But there are also known cases of completion this process by the 5th year of a child’s life.

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Problems in an adult

For an adult whose age does not exceed 40 years, in the absence of diseases from the cardiovascular system, the presence of an open oval window in the heart area does not interfere with full image life.

An open foramen ovale in the heart in an adult whose age category has crossed the threshold of 40 years, when diseases related to the heart and blood vessels occur, can complicate the treatment of the disease.

If a doctor suspects this heart pathology, the patient should be referred for diagnosis using ECG, radiography and echo-CG.

The presence of the disease in athletes

The life of an athlete is closely connected with physical activity of increased severity.

When performing tasks, this pathology may manifest itself as the following symptoms:

• the appearance of shortness of breath;
• expressed in the athlete’s low activity, which is facilitated by his rapid fatigue;
• the appearance of fainting conditions;
• presence of severe headaches, migraines;
• manifestation of signs of suffocation (lack of air).

If these symptoms are detected, you must immediately consult a doctor to undergo a full examination and prescribe medication.

One of the methods is surgical intervention. The ability to remain in professional sports should only be decided by a doctor, based on the diagnostic results.

Since the presence of this pathology can lead to the formation of blood clots in the heart area, this is fraught with the development of the next series of diseases, which, due to failure to provide timely treatment, medical care can be fatal:

• myocardial infarction;
• stroke;
• kidney infarction.

Signs and manifestations of pathology

Any disease is accompanied by the presence of its own symptoms.

Signs of an open oval window in childhood the following:

1. The baby's weight gain occurs very slowly.
2. In cases where a child cries, strains, screams, coughs, sharp blueness or severe pallor of the skin around the lips occurs.
3. The child often suffers from bronchopulmonary and colds.

At an older age, children may experience shortness of breath and increased heart rate when performing physical activity.

IN adolescence this pathology is reflected in the following signs:

• rapid fatigue of the body;
• frequent headaches;
• the presence of dizziness leading to fainting;
• the presence of interruptions in the functioning of the cardiac system.

In adulthood, especially if the age category is beyond 40 years, the signs will be as follows:

1. The presence of frequent colds and respiratory diseases.
2. Lack of pulse regularity.
3. The presence of weakness and high fatigue of the body.
4. The appearance of shortness of breath.
5. Presence of loss of consciousness.

Functioning heart problem

Preservation of the function of the oval window in cases of a measured life rhythm associated with the lack of frequent physical activity, does not pose a danger to the human body.

But there are cases in which maintaining the functionality of the oval window contributes to the development of a number of unpleasant consequences:

1. Age-related growth of organs and tissues, when the heart muscle grows, but the valve remains the same size. Blood, due to an increase in the oval window connector, can freely penetrate from one atrium to another, which leads to an increase in the load on them.
2. Diseases that increase pressure in the right atrium. This factor promotes the opening of the valve towards the left atrium.
3. In cases of primary pulmonary hypertension, the preserved functionality of the oval window may help positive influence on the human body. Part of the blood from the pulmonary circulation is discharged through the oval window into the left atrium, thereby helping to reduce pressure.

The presence of constant monitoring by a doctor is typical for these situations, so that the moment of transition to a decompensated state of the patient is not missed.

Of course, a person can live a full life with this pathology. But everyone needs to be diagnosed for the presence of an open oval window.

Methods for treating an unclosed oval window

It should be said that an unclosed foramen ovale is a pathology in which there is a gap between the right and left atria. It can occur with noticeable symptoms, for example, pale skin, blue lips, hands and feet, frequent dizziness, loss of consciousness, and a predisposition to frequent colds.

This problem occurs most often in newborns. But there is no reason to worry, since it can go away in two years, and if it doesn’t go away, then special operations are currently being carried out using the latest methods.

However, it can occur without any symptoms, then there is no need for treatment.

If there is a small discharge of blood, there is no previous disease and there are no consequences after it, the operation is not performed.

Then such patients, if a transient ischemic attack or a history of stroke occurs, are prescribed general therapy with the following drugs to prevent thromboembolic complications:

1. Anticoagulants. The most popular anticoagulant is Warfarin (Coumadin). However, when using such medications, it is necessary to take frequent blood tests to monitor the state of the hemostatic system in order to protect the patient from blood clots.
2. Antiplatelet agents or antiplatelet drugs. The most common representatives of this group of drugs is Aspirin, used at 3-5 mg/kg every day. When aspirin enters the body, it acts on the platelet cell, which then remains inactive for some time to aggregation, or, more simply, to the process of gluing during the formation of blood clots. If Aspirin is used every day in small doses, this provides reliable prevention of venous insufficiency, as well as venous thrombus formation and ischemic stroke.

But with a strong pathological discharge of blood from the atrium with right side a low-traumatic x-ray endovascular occlusion of an unclosed window is performed on the left. This entire procedure is controlled by special X-ray and echocardiological devices using an occluder, which, during opening, closes all holes.

The operation and the use of the drugs described above are used to treat an unclosed oval window, both in adults and children.

Help from folk remedies at home for this illness

Unfortunately, folk remedies from this pathology has not yet been identified.

If a person does not have obvious disorders in the functioning of the cardiovascular system, then doctors give him advice on how to lead a lifestyle, and may also prescribe some vitamins and proper nutrition, helping to support heart function. It is also recommended for a person with an unclosed oval window to limit physical activity. And here medications in the absence of symptoms, the patient is not discharged; they can only prescribe procedures to strengthen the body, for example, hardening, exercise therapy, and sanatorium-resort treatment.

But if the patient has minor complaints about the heart when the oval window is not closed, the doctor sometimes prescribes special fortified medications that strengthen the cardiovascular system, such as Panangin, Magne B6, Elcar, Ubikhion, etc. And in case of severe disturbances in the functioning of the cardiovascular system, it is used general therapy with the drugs described above or undergo surgery.

Nutrition rules for an unclosed oval window

In addition to drug treatment for an unclosed oval window, you need to follow proper nutrition, which has some features. All people with such a difficult disease must adhere to a strict diet.

Namely, do not eat fried, smoked or salted foods. Include more in your diet fresh vegetables and fruits, as well as consume legumes, cereals, pasta, greens, low-fat lactic acid products, fish, low-fat varieties meat, as well as foods rich in potassium, such as grapes, kiwi, citrus fruits, baked potatoes and many others. Eliminate strong tea and coffee from your diet; it is better to replace them with freshly squeezed juices and dried fruit compotes. Food should be taken in small quantities and often.

Below is a sample menu for 5 meals a day:

1. Breakfast - pumpkin porridge, wholemeal bread, a glass of kefir, 1 apple, 1 orange.
2. Second breakfast - 1 banana, 1 apple.
3. Dinner - pea soup, a piece of boiled lean fish, a piece of bread made from second-grade flour, dried fruit compote.
4. Afternoon snack – skim cheese, kefir.
5. Dinner – boiled potatoes with boiled chicken breast, second-grade bread, dried fruit compote, 1 orange.

Under no circumstances should you drink alcohol or smoke. Sleep time should be between 8 and 12 hours. Do light exercise. It is also very useful for this problem to eat more nuts, because they contribute to the normal functioning of the heart.

Possible complications and prognosis of an unburied oval window

In many cases, there are almost no complications with this pathology.

This unusual structure of the heart sometimes causes the following problems:

• myocardial infarction;
• stroke;
• kidney infarction;
• transient change in cerebral circulation.

All these problems occur due to paradoxical embolism. Although this happens extremely rarely, the patient is always obliged to tell his doctor that he has a patent foramen ovale.

Almost always, the prognosis for people with this disease is not very dire, and, as already mentioned, it ends without complications at all.

People with this problem should always follow these recommendations:

• be examined by a cardiologist every year;
• undergo an Echo-CG test;
• do not engage in strenuous sports;
• exclude work associated with heavy respiratory and cardiac stress, for example, divers, firefighters, astronauts, pilots, etc.

TO surgery come only in the most emergency situations, during pronounced changes in the performance of the cardiovascular system and respiratory organs.

And in conclusion, we can add that an unclosed oval window is a pathology that does not cause much harm to human health and life, unless there is a risk of a defect or some other heart disease. This depends on numerous factors.

Indications for abdominal ultrasound

IN this moment Ultrasound, or ultrasound, is one of the most popular diagnostic methods. It is non-invasive - that is, ultrasound does not require a violation skin– and, accordingly, absolutely painless. Discomfort can only be caused by the fact that the special gel that is used to lubricate the skin of the abdomen before the examination is usually cold.

Ultrasound is prescribed quite often: for any discomfort in the area abdominal cavity, since it is often on the basis of this study that a preliminary diagnosis is made.

Indications for it may include:

1. Pain in the abdominal area, especially acute.
2. Nausea.
3. Increased gas formation.
4. Belching.
5. Changes in the shape or size of the abdominal organs, revealed visually or by palpation.
6. Suspicion of the presence of pathological formations in the abdominal cavity or organs: benign or malignant tumors, stones in the gallbladder.

The causes of increased gas formation, nausea and pain are usually found out during an ultrasound examination. In addition, such a study “catches” even the smallest stones - they often become the cause of severe pain. And it is done much faster than a blood test, making it easy to make a diagnosis even before the results of urine and blood tests arrive.

In addition, an abdominal ultrasound is performed if diabetes is suspected.

How is ultrasound performed?

Ultrasound examination is performed for research the following bodies abdominal cavity:

• liver;
• spleen;
• gallbladder;
• pancreas;
• The lymph nodes;
• blood vessels.

I would like to draw your attention to the fact that bladder refers to the pelvic organs, that is, to the list of organs for which it is carried out ultrasound diagnostics abdominal cavity, not included. Another important detail is that the organs of the digestive system located in the abdominal cavity: stomach, intestines except the caudal section are not subject to ultrasound due to large cluster gases Therefore, they prefer to use other diagnostic methods to study them.

Typically, an ultrasound is performed in the morning - this is much easier due to the patient's need to follow a diet. After all, if the study is scheduled for the afternoon, the patient will have to not eat long time. Conducted by a highly specialized doctor whose task is correct execution diagnostics and interpretation of device indicators. An ordinary therapist or any other medical professional, without a trained ultrasound specialist, does not have the right to do this.

To conduct this study, doctors use special devices - so-called echotomoscopes. A gel is applied to the skin of the patient’s abdominal cavity, thanks to which ultrasonic waves pass freely through the patient’s skin, as a result of which the image on the device screen is stabilized. The doctor then moves a hand-held sensor over the patient's body. Sometimes, in order to better see a certain organ, it is necessary to hold your breath or change your posture.

Also, if you feel strong enough and sharp pains, It may be quite unpleasant for you strong pressure on the skin, which is sometimes required to obtain more accurate results.

Nutrition before ultrasound

Ultrasound diagnostics is a very important research method, therefore it is necessary to prepare thoroughly for it. Of course, if an ultrasound is performed urgently, it is simply impossible to prepare, since the diet must be followed for several days.

Three to four days before the test, you need to exclude from your diet the following foods:

• legumes, which are prohibited under no circumstances: they cause increased gas formation;
• flour products, including bread, any pastries;
• you will also have to give up raw vegetables and fruits;
• dairy products and milk itself are prohibited;
• should not be eaten sauerkraut, raw, too, however;
• carbonated drinks.

In addition, you will need to do without bad habits. Drinking drinks containing alcohol, smoking is prohibited, even chewing gum is a prohibited product.

Doctors recommend a cleansing light diet. You can eat lean meat or fish: boiled or steamed, stewed or boiled vegetables, cereal porridge. They are prepared with water and a minimal amount of oil and salt is added.

Mandatory requirements also include the need drink plenty of fluids. These days you should consume at least one and a half liters of fluid, or better yet, even more. Water and unsweetened tea are allowed, in as a last resort with very little sugar. Coffee and juices will have to be excluded before the ultrasound.

The last meal should occur no later than five hours before diagnosis. This is important: a full stomach or intestines prevents the specialist from examining the abdominal organs in detail; moreover, they are compressed, which can lead to inaccurate data. For the same reason, overeating is excluded a few days before the study; you need to eat fractionally, in small portions.

How to prepare for an abdominal ultrasound if you have problems with increased gas formation

This happens quite often - many people experience increased gas formation or constipation. In this case, you should take the advice of doctors and take a short course of medications. And after the ultrasound, you can continue the course of these pills to bring your intestines back to normal.

So, if your intestines are swollen, you need: Enterosgel and/or Smecta. These drugs help normalize the amount of gases formed in the intestines. In addition, activated carbon is often prescribed, but its popularity is gradually declining as modern drugs show themselves to be more effective than traditional means.

In the opposite situation - with constipation - you may be prescribed Festal or Mezim Forte. They help improve intestinal secretory function. You should also take care of cleansing your intestines. The evening before the test, take a laxative.

If this does not help, put on a rectal suppository - they are sold everywhere in pharmacies, for example, Bisocadil or Dulcolax. You can also do a cleansing enema, but this should never be overused, as it can damage the intestinal mucosa. One enema is quite enough, and only if it does not help at all, you can give a second one.

Also, people who have problems with the gastrointestinal tract should be as precise as possible with their diet. Those who have flatulence should completely exclude vegetables from the diet, even boiled ones, replacing them with porridges: for example, pearl barley or wheat. For people with constipation, on the contrary, it is better to increase the amount of boiled or stewed vegetables: they weaken the intestines. But porridge should be consumed with caution, just like meat. Despite the fact that this is the most light diet, cereals and protein foods can cause constipation.

A small opening between the left and right atria, which forms during fetal development, is known as a patent foramen ovale.

What is special about its formation and does it pose a danger to human life?

The essence of LLC

This problem is normal for a fetus, but in adults it is an anatomical feature of the structure of the heart.

The human heart consists of 4 cavities: two atria and two ventricles, which are closely interconnected through special channels. Between the right and left atria is the interatrial septum.

Its role is to regulate blood flow from the left atrium to the right. There are often cases when this septum is formed incorrectly, forming a hole - an open oval window.

The process of blood circulation in children and adults has some differences: during the development of the fetus in the womb, its lungs do not participate in the respiratory process. In this regard, only 12% of the total blood flow passes through them.

This is necessary to enrich the internal organs of the fetus (brain, liver, etc.) with oxygen, which is contained in the blood passing through them.

The direction of blood in the fetus's body is regulated by special messages that are in its heart - vascular system, for example, arterial and venous blood flows. Patent foramen ovale is also one of these reports. It pumps oxygenated blood from the right atrium to the left, thereby reducing the flow of blood into the fetal lungs.

From the inside of the cavity of the left ventricle, the opening is covered with a small valve. Before the onset of labor, this valve is already fully formed.

After a newborn baby makes its first cry, its lungs open and oxygen and blood flow into them. This causes the valve to close and increase the pressure level in the left atrium.

After some time, the walls of the valve leaflets gradually grow to the walls of the interatrial septum. This process is finally completed during the first year (in rare cases - by 5 years).

It is possible that the valve leaflets are too small, which cannot ensure complete closure of the opening between the atria. It is in this case we're talking about about the development of OO windows.

According to statistics, an open foramen ovale in adults (in 30% of all cases) entails the development of various diseases of the cardiovascular system or pulmonary pathology.

The main reason for this situation is the increased intracardiac blood pressure. Since the development of this problem begins in the prenatal period of fetal development, in adults PFO is considered a heart defect.

Causes

As a result of the fact that the open oval window remains open or slightly open, when severe cough, crying or as a result of abdominal tension, blood is ejected from the right atrium into the left. This is a clear manifestation of the action of an OO window.

To date, experts have not been able to fully understand the exact reasons that lead to the occurrence of this pathology. Among known factors include:

• hereditary factor;
• prematurity;
• congenital defect of the mitral or tricuspid heart valves;
• dysplasia connective tissue;
• negative environmental impact;
• smoking;
• drinking alcoholic beverages during pregnancy.

Experts also include in the risk group people whose bodies are exposed to heavy physical stress, including athletes. You should also not exclude from this group those whose profession involves diving to great depths.

Patients diagnosed with thrombophlebitis of the legs or MT, accompanied by moments of pulmonary embolism, usually suffer from increased pressure on the right side of the heart, and are also at risk for developing a functioning PFO.

If a person is at risk or a pregnant woman has been exposed to the above factors, you should immediately contact a specialist to undergo comprehensive examination. This can reveal the presence of pathology and prevent heart disease.

Symptoms, dangers and treatment

As a rule, an open oval window is small in size and does not cause any discomfort in patients.

If PFO was not diagnosed and eliminated in childhood, this anomaly can provoke manifestation of such signs:

• fast fatiguability;
• weakness;
• exposure to frequent respiratory infections: cough, sore throat, bronchitis, etc.;
• shortness of breath, which tends to manifest itself not only during heavy physical exertion, but also during moderate exercise;
• dizziness;
• severe headaches;
• migraine;
• frequent fainting conditions.

Unfortunately, it is not always possible to identify the OO window during a routine medical examination. Typically, pathology is discovered only after the patient begins to exhibit complications of this anomaly.

WITH Some of the most common complications include:

• transient type of cerebral circulatory disorder - characterized by short-term disturbances in the functioning of the human brain. The main reason for this is the failure of the blood supply process in the GM. In this case, the person experiences loss of speech, memory, numbness of the upper or lower limbs, disruption of the activity of certain parts of the body. The maximum duration of manifestation of these symptoms does not exceed a day;
• stroke is quite severe and dangerous complication LLC, which consists of the death of certain areas of muscle tissue. In this case, the patient exhibits symptoms similar to those seen in a transient disruption of the blood supply to the brain. A distinctive feature of this condition is that the duration of manifestation of these symptoms is much more than 24 hours;
• kidney infarction - manifests itself in the form of death of part of the kidney, which is accompanied by severe pain in the lumbar region, bloody discharge in the urine, a small amount of urine excreted, increased body temperature.

It is also worth noting that a patent foramen ovale is extremely dangerous for people who dive. This is due to the fact that they are at increased risk of developing decompression sickness. In order to obtain permission to dive below 10 meters, such people need to close the LLC.

A patent oval window is dangerous possible development complicated processes. To reduce the risk, you should immediately contact a specialist for a comprehensive examination.

The choice of treatment method for this pathology depends on the size of the oval hole, the presence of complications, as well as concomitant diseases.

Usage drug therapy will not cause the window to close completely. For this purpose, the method of surgical catheterization or surgery is used. In most cases, the pathology does not require treatment. Patients with this anomaly live a long and full life, work and have children.

In order to avoid the development of complications, children diagnosed with a patent foramen ovale should be under the supervision of specialists. As for adult patients, they should also undergo periodic medical examinations.

Article publication date: 02/10/2017

Article updated date: 12/18/2018

From this article you will learn: in which cases an open foramen ovale in a child’s heart is a normal variant, and in which cases it is a heart defect. What happens with this condition, can an adult have it? Treatment methods and prognosis.

Oval window- this is a channel (hole, passage) in the area of ​​the interatrial septum of the heart, providing one-sided communication between the cavity of the right atrium and the left. It is a vital intrauterine structure for the fetus, but after birth it must close (overgrow) as it becomes unnecessary.

If healing does not occur, the condition is called a patent foramen ovale. As a result, oxygen-poor venous blood continues to be discharged from the right atrium into the cavity of the left. It does not enter the lungs, where it should be ejected from the right half of the heart to be saturated with oxygen, but immediately, once it reaches the left side of the heart, it spreads throughout the body. This leads to oxygen starvation - hypoxia.

Staying open after birth is the only violation of the oval window. But not in all cases this is regarded as a pathology (disease):

• Normally, in all newborns the window is open and can function periodically.
• Overgrowth occurs gradually, but individually for each child. Normally, in children older than one year, this channel should be closed.
• Availability of small open area Foramen ovale occurs in 50% of children aged 1–2 years. If there are no manifestations of the disease, this is a normal variant.
• If a child has symptoms in the first year of life, and also if the oval window functions in children older than 2 years, this is a pathology - a minor anomaly of heart development.
• For adults and children over 2 years of age, the window should be closed. But under certain circumstances, at any age, it can open, even if it is overgrown in the first year of life - this is always a pathology.

This problem is treatable. Treatment is carried out by cardiologists and cardiac surgeons.

What is a patent oval window for?

The heart of the fetus in the womb contracts regularly and provides blood circulation to all organs except the lungs. Oxygen-enriched blood reaches the fetus from the placenta through the umbilical cord. The lungs do not function, and the underdeveloped vascular system in them does not correspond to a formed heart. Therefore, blood circulation in the fetus bypasses the lungs.

This is what the oval window is designed for, which drains blood from the cavity of the right atrium into the cavity of the left, which ensures its circulation without entering the pulmonary arteries. Its peculiarity is that the hole in the septum between the atria is covered by a valve on the side of the left atrium. Therefore, the oval window is capable of providing only one-way communication between them - only right to left.

Intrauterine blood circulation in the fetus occurs according to the following scheme:

1. Oxygenated blood flows through the umbilical cord vessels into the fetal venous system.
2. By venous vessels blood enters the cavity of the right atrium, which has two exits: through the tricuspid valve into the right ventricle and through the oval window (an opening in the septum between the atria) into the left atrium. The vessels of the lungs are closed.
3. The increase in pressure during contraction pushes back the oval window valve, and part of the blood is dumped into the left atrium.
4. From it, blood enters the left ventricle, which ensures its movement into the aorta and all arteries.
5. Through veins connected to the umbilical cord, blood enters the placenta, where it mixes with the mother's.

The oval window is an important structure that provides blood circulation to the fetus during the intrauterine period. But after the birth of a child, it should not function and gradually overgrows.

Possible development of pathology

At birth, the fetal lungs are well developed. As soon as the newborn baby takes his first breath and they are filled with oxygen, the pulmonary vessels open and blood circulation begins. From this moment on, the baby's blood is saturated with oxygen in the lungs. Consequently, the oval window becomes an unnecessary formation, which means it must heal (close).

When this happens - the process of overgrowing

The process of closing the oval window occurs gradually. In every newborn it can function periodically or constantly. But due to the fact that after birth the pressure in the left cavities of the heart is much higher than in the right, the window valve closes the entrance to it, and all the blood remains in the right atrium.

Children of the first year of life

The smaller the child, the more often the oval window is open - about 50% of children under one year old. This is an acceptable phenomenon and is associated with the initial degree of development of the lungs and their vessels at the time of birth. As the child grows, they expand, which helps reduce pressure in the right atrium. The lower it is in comparison with the left one, the more tightly the valve will be pressed, which should be firmly fixed (fused with the walls of the window) in this position for life.

Children of the second year of life

It happens that the oval window only partially closes (1–3 mm remains) by 12 months (15–20%). If such children develop normally and do not have any complaints, this is not considered a deviation from the norm, but requires observation, and by two years it should completely close. Otherwise, it is regarded as a pathology.

Adults

Normally, in children over two years of age and in adults, the oval window should be closed. But in 20% it either never heals or re-opens throughout life (and then is from 4 to 15 mm.

Six reasons for the problem

Six main reasons why the oval window does not heal or open:

1. Harmful effects on the fetus (radiation, toxic substances, medications, intrauterine hypoxia and other complicated pregnancy options).
2. Genetic predisposition (heredity).
3. Prematurity.
4. Underdevelopment (dysplasia) of connective tissue and heart defects.
5. Severe bronchopulmonary diseases and pulmonary embolism.
6. Constant physical stress (for example, crying or coughing for young children, intense exercise and sports for adults).

Pathological signs and symptoms

The discharge of oxygen-poor blood through the open foramen ovale into the heart leads to oxygen starvation in all organs and tissues - to hypoxia. The larger the diameter of the defect, the greater the discharge and the stronger the hypoxia. This can cause the following symptoms and manifestations:

About 70% of people with open channel do not make any complaints. This is due to the small size of the defect (less than 3–4 mm).

How to diagnose the problem

Diagnosis of pathology - ultrasound of the heart (echocardiography). It is better to perform it in two modes: standard and Doppler mapping. The method allows you to determine the size of the defect and the nature of circulatory disorders.

Image of a large patent foramen ovale during cardiac ultrasound. Click on photo to enlarge

Treatment

When deciding on the need for treatment and choosing the optimal method, two factors are taken into account:

1. Are there any symptoms or complications:

• if yes, surgery is indicated, regardless of the size of the defect;
• if not, treatment is not required in both children and adults.

1. What are the dimensions of the defect and the amount of blood discharge according to echocardiography: if they are pronounced (more than 4 mm in a child) or there are signs of cerebral blood flow disorders in adults, surgery is indicated.

The oval window can be easily closed using a procedure that is performed without a single incision through a puncture of one of the large arteries.

Endovascular surgery to close the oval window in the heart

Forecast

The asymptomatic course of an open oval window in adults and children does not pose any threats and restrictions in 90–95%. In 5–10% of cases, when unfavorable circumstances (lung disease, heart disease, hard work) are added to this anomaly, a gradual increase in the defect is possible, resulting in clinical manifestations and complications. Operated patients recover in 99%. All adults and children with a patent foramen ovale should visit a cardiologist once a year and undergo an ultrasound of the heart.

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 and a defect in interatrial septum(ASD) 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” (fetal) structures in the 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 one can find other signs of decreased strength and formation of collagen in the 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 certain medications during pregnancy. Most often, this pathology is 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. However, taking NSAIDs is dangerous late dates 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. In the presence of other heart defects.

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 lag in physical development.

Diagnostic methods

Echocardiography 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 an ultrasound examination of the heart, performed not through the chest, but the so-called transesophageal echocardiography. In 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 for identifying PFO

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 x-ray of the organs are possible chest(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 decompression sickness is 5 times higher than among a healthy population.
2. In addition, this category of people may develop a phenomenon such as paradoxical embolism. This phenomenon possibly in people with a tendency to form blood clots in the vessels of the lower extremities. 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 foramen ovale are more likely to develop a disease such as septic endocarditis. This is due to the fact that microthrombi can form on the walls of the valve flap.

Methods of treatment and prevention of complications

If the course of the pathology is favorable and the size of the oval window is small, according to cardiac ultrasound, no specific treatment is 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 the work and rest schedule, as well as dosage physical exercise.
• 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 arterial 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 a local inflammatory reaction in the 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 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 - the placental-uterine circulation.

All these factors contribute to the fact that the heart begins to beat faster, and the pressure in the pulmonary artery increases. 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.

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

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In a healthy person, the heart consists of four chambers, two of which are separated by a thickened septum that prevents blood from flowing from the left to the right. Sometimes the connecting fragment is modified and turns into a gap, causing defectiveness. Foramen ovale in the heart is a congenital disease in a newborn child, which is characterized by the formation of an opening between the right and left atrium. Pathology can be caused by a hereditary factor and, in especially rare cases, chronic diseases, disrupting the proper flow of blood through the chambers of the heart.

In children under the age of five, the presence of a gap in the heart is normal, but if the anomaly develops at an older age, then it is necessary to be regularly examined by a doctor, because the disease has serious complications.

An open foramen ovale in the heart in children is usually closed by a valve immediately after birth due to an increase in pressure in the first atrium, and subsequently fuses with the wall of the septum. But in some cases, the valve is too small to close the gap, and then the pathology becomes aggravating.

Patent foramen ovale in the heart

The causes of an open foramen ovale in the heart in a 6-7 year old child are determined by several factors:

• bad ecology;
• heredity;
• bad habits during pregnancy;
• poor nutrition during gestation;
• use of drugs prohibited during pregnancy;
• stress.

In rare cases, pathology develops against the background of disorders that increase tension in the right atrium and, thereby, open the valve to the left. Such processes include persistent lung diseases, vein thrombosis, other cardiac disorders, as well as gestation and childbirth.

An open foramen ovale in the heart in a child under the age of five does not cause concern on the part of the doctor, but an examination by a cardiologist is mandatory at least once a year. If this requirement is not taken into account, the disease may be diagnosed at an older age with acquired abnormalities in the functioning of the cardiovascular system and other aggravating consequences.

An open foramen ovale in the heart in an adult is a consequence of neglect of treatment methods when identifying the disease or lack of diagnosis throughout life caused by incompetence of research methods. Sometimes the defect is discovered during the examination of other heart defects, when dysfunction of the interatrial septum is detected and, accordingly, the valve opens.

Symptoms

An open foramen ovale in the heart has mild or pronounced symptoms depending on the size of the hole. With a gap of no more than 5-7 mm, no signs are observed, except bluish lips(acrocyanosis of the skin) after physical exertion and paleness of the face.

Symptoms of an open oval face actively appear when the gap between the right and left atrium is more than 7 - 10 mm:

• regular blueness of the lips and area around the mouth, regardless of previous actions;
• retardation in physical development;
• violation of movement coordination;
• cardiopalmus;
• dyspnea;
• unexpected fainting;
• migraines and other types of headaches;
• frequent colds;
• the appearance of blood clots;
• VSD - vegetative vascular dystonia;
• numbness of the limbs;
• pressure surges;
• increase in blood volume in the lungs.

The acquisition of a pale blue tint on the lips and in the mouth area is the main indicator of pathology, especially if changes in the skin appear after holding your breath under water, severe physical exertion, as well as other heart and lung diseases.

Blueness of the nasolabial fold - bright pronounced symptom heart pathology diagnostics

If there are characteristic signs of pathology, additional research, allowing you to determine the size of the gap and the risks of complications.

Diagnosis of an open oval face in the heart is carried out only by instrumental methods:

• Ultrasound examination of the heart through the esophagus, which allows detailed identification of abnormalities in the structure of the heart;
• probing the cavities of the heart to examine the interatrial fissure and assess the patient’s condition for surgical interventions;
• electrocardiogram to obtain information about the interaction of all parts of the heart;
• Doppler ultrasound to study the blood flow of vessels near the oval window;
• X-ray showing enlarged atria on the picture if there is a large hole between them;
• duplex scanning, with which you can find out about the patency of the veins of the lower extremities and identify the presence of thrombosis.

The probing method has a number of contraindications and cannot be prescribed to patients with increased blood clotting, renal failure, thrombosis and embolism. If the method is incompatible with the patient’s health condition, another type of examination is used - ultrasound of the heart.

A routine examination of the patient and clinical blood tests cannot indicate pathology, so doctors immediately resort to a visual examination of the damaged segment.

If the size of the gap is small and there are no symptoms that interfere with the quality of life, medication and hospital treatment are not prescribed.

• increase the immune protective functions of the body through hardening;
• accept cold and hot shower to stimulate the heart;
• organize walks on fresh air;
• visit a sanatorium for cardiovascular diseases at least once a year;
• do not disturb the biological clock;
• eat only healthy foods, excluding fried meat, canned drinks and fast food from the supermarket;
• engage in physical therapy.

A patent foramen ovale in the heart can cause cardiovascular system, causing organ conduction disturbances and sharp jumps pressure.

In such cases, it is mandatory to appoint drug treatment, which allows you to stabilize the work of the heart:

• preparations containing magnesium;
• vitamins and medications that improve interaction between the chambers of the heart;
• tablets that stimulate the production of energy in the pinpoint regions of the heart.

For large openings with the formation of blood flow in the left atrium, it is indicated surgical intervention, in anticipation of which thrombosis prevention is carried out. Some time before the operation, the patient is given elastic bandages on the lower extremities and prescribe medications that inhibit blood clotting processes.

During surgery, a patch is inserted through the femoral vein using a catheter into the right atrium. When ingested, it opens up in the shape of an umbrella and covers the surface of the hole. Within a month, the patch is resorbed and activates the formation of connective tissue at the site of the gap. Thus, the open foramen ovale in the heart closes. Surgery is recommended only when difficult cases, when the size of the gap portends complications and is referred to as a heart defect.

The treatment method using a patch is an innovation in Russian medicine, but is already widely applicable. However, if such an intervention is not available due to external circumstances, then an occluding device is used during surgery, which is inserted according to the same principles as a patch.

The occluder inside the body opens in the shape of an umbrella and completely covers the oval window. The operation is used extremely rarely, because inflammation of the tissue around the occluder may occur. Preference is given to surgical interventions using a patch.

Types of occluders for closing an open oval window

If blood clots are detected in the veins of the legs, treatment of an open oval window is determined by constant observation by a phlebologist and monitoring of blood clotting.

Complications

If you do not follow the doctor's recommendations, even a slight gap in the chambers of the heart can lead to serious illnesses leading to sudden death. To avoid aggravating consequences, you need to avoid excessive physical activity, including diving, be constantly monitored by a hematologist for the appearance of blood clots, and visit a cardiologist at least once a year.

Among the complications congenital pathology highlight:

• decompression sickness, which destroys the walls of cells and blood vessels and leads to paralysis and death;
• paradoxical embolism, during which a blood clot breaks off, clogging vital arteries and creating a threat of death if it is large;
• septic endocarditis, affecting the cardiac channels and causing death;
• stroke, which occurs when a blood clot forms in an artery of the brain;
• myocardial infarction caused by blockage coronary arteries heart thrombus;
• kidney infarction due to blockage of the corresponding vessels;
• a violation of the cerebral blood supply, which damages motor and auditory functions and memory loss occurs.

The patient is obliged to warn the attending physician about the congenital pathology so that the risk of complications can be reduced or the existing symptoms can begin to be eliminated.

If you follow the doctor’s requirements and see a cardiologist once a year, the prognosis for an open foramen ovale in the heart will be quite favorable. You can be confident in longevity and not feel painful symptoms if you don’t overwork yourself in physical exercise, don’t dive under water and try to fly less on an airplane. Any actions that cause increased stress on the circulatory and respiratory systems lead to complications.

Patients who have undergone surgery due to a large oval window get rid of the defect forever and do not put their body at risk during surgery. After the operation, they lead a full life and after some time they can forget about previous lifestyle restrictions. However, if the size of the gap does not exceed normal limits, the operation is not recommended, because the pathology, to a greater extent, is in the nature of structural features of the heart, and not a serious illness. The patient's life is threatened only by complications that develop against the background of pathology.

Risk group

There are a number of professions that can have a fatal impact on the health of people with a patent foramen ovale in the heart.

It is sad that untimely diagnosis of pathology or a negligent attitude towards one’s own well-being leads to death. And all because with strong immersion or ascent, blood clots can form in the artery, blocking the vessel and foreshadowing instant death.

People with a patent foramen ovale in the heart should exclude the following professions and even one-time hobbies from their lives:

• pilot;
• astronaut;
• diver;
• diver;
• scuba diver;
• driver;
• driver;
• submarine crew;
• caisson workers;
• army employee.

When serving in the armed forces, conscripts are required to perform vigorous physical activity every day. Since the number deaths in the army has increased, and the main reason for this is heart disease, medical examination began to carefully examine each conscript. When diagnosed with an open foramen ovale in the heart, they become unfit for service and are sent for treatment to avoid blood clot detachment and blockage of blood vessels, which pose a threat to life.

Heart pathology caused by the formation of an open oval window is not a death sentence, but requires constant monitoring by a doctor and unquestioning adherence to the treatment regimen.

If you take care of yourself, don’t overexert yourself, exclude active sports and eat right in the presence of such an anomaly, then you can feel completely healthy person and live a long life.

If you take risks, knowing about your disease, and dive under water, fly on an airplane, or experience grueling physical activity, then you can predict with an 80% probability the development of an embolism, which will result in disability or death.

During the prenatal period future baby receives a set of necessary nutrients from mother. This also applies to oxygen supplied with the placental bloodstream through the open foramen ovale in the child. It looks like a small hole between the atria of the heart. After birth, the need for it disappears, but not everyone closes it.

Description of the problem

The patent foramen ovale (PFO) is a small opening between the atria of the heart. Its main purpose is to deliver oxygen by bypassing the pulmonary circulation, which does not function during the prenatal period. For this purpose, the window has a special valve that acts as a door, which opens only towards the left atrium, allowing a flow of oxygen and blood into it.

After birth, the need for a window disappears as the first breath opens the lungs. They “turn on” the pulmonary circulation, increasing pressure in the left heart chambers. As a result, the valve-shaped door is no longer able to open, is pressed tightly against the interatrial septum and gradually becomes overgrown.

Important! Typically, complete closure of the window occurs between 3 months and 2 years of age. But sometimes this happens at a later date. IN last years open window often began to be diagnosed at the age of 5 or 7 years.

It is worth talking about heart problems in cases where the child’s heart is growing, but the growth of the valve in the window area does not keep up with it. This leads to the fact that the window does not close tightly and blood begins to circulate between the atria, which should not happen. There is a certain percentage of people who do not experience any particular discomfort from an unclosed oval window.

Sometimes the load on the heart increases, which causes a surge in blood flow between the atria. This can be caused by pathology of the veins in the lower extremities, concomitant heart diseases and chronic illness lungs. Often, pathological blood flow is provoked by pregnancy and childbirth. Here it is very important to monitor the doctor and carry out complex treatment if necessary.

Normal sizes of the oval window

According to statistics, an open oval window is diagnosed among 25% of all adults and is not a pathology. It does not pose a serious threat and is simply a physiological feature of the body. The window sizes can vary from 3 mm to 19 mm and largely depend on the person’s age and height. The smallest diameter can be observed in a one-month-old baby.

A hole of 5–7 mm is not particularly dangerous. Such a small size in young patients eliminates the shunting of blood between the atria. And only severe crying, coughing or physical overload can provoke the flow of blood from one atrium to another. In adulthood, this can result from diving, doing gymnastics or weightlifting, or working as a pilot, diver or miner.

The need to eliminate the hole directly depends on the size of the cover valve and the degree of compensation. The choice of appropriate therapy is within the competence of experienced specialist, which takes into account a number of features and factors. When the window size exceeds 7–10 mm, the question of whether surgical treatment.

Window closing process

When the need for the oval window disappears, a process of gradual overgrowth occurs. However, it can function periodically. Most often this happens in children in the first year of life, whose lungs and blood vessels are not yet sufficiently developed. Therefore, with prolonged crying or straining, the hole opens, allowing a small amount of blood to pass from one atrium to the other.

But as they grow, the cardiovascular system strengthens and intracardiac pressure changes. As a result of this, the window door fits very tightly and gradually fuses with the walls of the heart. In most cases this occurs by the age of two. But sometimes it depends on the individual characteristics of the body and occurs a little later, which is also a variant of the norm.

Provoking factors

In recent years, the number of people with a patent foramen ovale has increased. This usually happens in babies born prematurely or as a result of genetic characteristics body.

Other reasons may also contribute to non-closure:

• harmful effects on the cardiovascular system in the prenatal period (use of various medications, hypoxia and radiation);
• underdevelopment of connective tissue of the heart and various defects;
• severe lung disease;
• constant physical activity and overexertion;
• pulmonary embolism.

Important! Experts do not consider a patent foramen ovale as a heart defect. It is usually classified as a minor anomaly in the process of heart formation (MARS). Most people live with it their whole lives without experiencing any particular inconvenience. But only with regular monitoring by a cardiologist.

Leading symptoms

The blood circulating between the atria through the foramen ovale is particularly oxygen poor. Its constant supply leads to oxygen starvation of the body, which is accompanied by characteristic symptoms.

With small window sizes (from 3 to 4 mm), the listed symptoms appear extremely rarely.

Diagnostic measures

Often, a routine physical examination by a specialist can help you suspect the presence of an open window. It allows you to detect cyanosis of the skin and retardation in physical development. Additional signs will include heart murmurs during auscultation (listening with a phonendoscope) and studying the anamnesis (frequent acute respiratory viral infections and fainting).

Instrumental diagnostics allow you to establish an accurate diagnosis:

• ECG: allows you to detect signs of overload of the right heart;
• Chest X-ray: reveals an increase in the size of the heart;
• probing of the heart cavities: performed only before surgery;
• Echo CG (ultrasound of the heart): allows you to visually determine the presence of a defect and its size, as well as a graphic image of the movement of its valve.

Using Doppler echocardiography, turbulent blood flow, its volume and speed can be detected. And transesophageal ultrasound cardiography (EchoCG) allows you to obtain the most accurate information due to significant visualization.

Treatment tactics

An open window is a variant of the norm in the absence of severe symptoms, without requiring special therapy. In this case, it is enough to be regularly observed by a cardiologist and the correct dosage of physical activity. But at the first signs of stroke or transient ischemic attacks, therapy is mandatory.

Most often, antiplatelet agents and anticoagulants (Aspirin, Warfarin) are used as medications with regular monitoring of the international normalized ratio (INR). Its indicators must be in a certain range (from 2 to 3), which is determined using laboratory tests.

If there is a pronounced pathological blood discharge between the atria, the issue of performing an operation is decided. To stop the flow of blood, endovascular occlusion is performed under the control of X-ray and echocardiograph. A special occluder allows you to completely close the hole, which the doctor inserts through a vein in the thigh using a catheter.

Probability of complications and prognosis

The presence of an oval window is always a risk factor for certain disorders or complications. An example is paradoxical embolism. This pathological condition, in which small blood clots and air bubbles can enter through the window into the atrium and then into the ventricle on the left. They can eventually reach the brain and cause a stroke.

Regular visits to the doctor and necessary research. Under the constant supervision of a doctor, the prognosis for this defect is quite favorable. And performing endovascular occlusion makes it 100 percent favorable.

There are no specially developed measures to prevent an open oval window. But it is quite possible to reduce the risk of its development in the prenatal period. For this to the expectant mother should be carried out healthy image life, eat right and eliminate all bad habits.

In addition, any contact with chemicals (paints, varnishes, dangerous drugs) and ionizing radiation should be avoided. While carrying a baby, a woman should try to take care of her health and not have contact with sick people. Infectious diseases significantly increase the risk of cardiac pathology in the fetus (especially rubella).

When a child has already been diagnosed with a foramen ovale in the heart, the most important thing is not to panic. This is not a sentence. In this case, parents need to follow a number of useful recommendations:

• register your child with a cardiologist;
• learn to dose physical activity;
• organize your daily routine correctly;
• develop together with the doctor proper diet nutrition;
• try to vacation at sea every year.

Important! It is necessary to show your child your confidence and calmness. No need to scare him in medical terms and exhibit excessive health concerns. Instead, you need to take care of his mental and psychological comfort.

Modern diagnostic methods allow specialists to timely detect an open foramen ovale in newborns. And until a certain age, this is not a pathology, since after a certain time it should close on its own. But in some cases this does not happen, which requires professional help from the experts. And the comfort and quality of life of a growing baby directly depends on the timely identification of the problem and its competent solution.

Nowadays, quite often, during the first examination, parents may be informed that an open foramen ovale has been detected in the child’s heart. Initially, the fetus has such a hole between the atria in the womb in order to ensure normal blood supply.

Usually, before it is born, it should be completely overgrown, since it is simply no longer needed. Let's figure it out: an open oval window in children is a really serious pathology or just one of the structural features of the body.

Features of the disease

heart diagram with LLC

The interatrial septum in humans performs important function– it prevents blood from mixing with each other. But in newborn children, this septum is not always a complete structure. Initially, this is necessary for better oxygenation of the brain, but in a normal state in a newborn, the hole should already be completely closed. At the moment of the first cry, the pressure in the lungs increases and the valve completely closes the window.

Up to 5 years it completely fuses with the walls, but in some cases it may be too small in size to completely close the hole. But do not confuse LLC with a septal defect - these are completely different things. A septal defect is a much more complex pathology, which is a heart defect. In this case, then it is worth saying that the valve completely fails to cope with its functions.

At the same time, it is worth understanding that closing the “window” in a child’s heart is individual for each baby and therefore it is impossible to clearly determine the standard period when exactly the valve should grow to the walls.

For some babies this happens at one, two, three, five years - it all depends on the individual characteristics of the body. Ideally, closure of the oval window in the heart of a newborn occurs in the first 3 months after the birth of the baby.

Hole dimensions

Further prognosis, as well as the need for surgery, directly depends on the size of the opening of the open oval window in children:

• 2-3mm - with such a deviation from the norm, no serious consequences cannot be and therefore there is no need for any treatment;
• small size – 5-7mm. In this situation, everything depends on the accompanying provoking factors;
• more than 7mm ( maximum size– 19mm) – gaping hole. Requires surgery;

Statistics show that in adults, large openings of the oval window in the heart are very rare. This indicates that there is no reason to panic.

Causes

In medicine, it is customary to identify a number of main provoking factors that can cause the problem of an open oval window in an infant.

These include:

• genetic predisposition. This is the most common cause of this problem. Maternal predisposition is especially common;
• frequent stress during pregnancy;
• birth of a baby prematurely;
• exposure to negative environmental factors on the pregnant woman’s body;
• taking alcohol, drugs, illegal medications, smoking.

Symptoms of the disease

Often, a patent foramen ovale in newborns can be detected during a routine examination. But sometimes a number of basic symptoms may indicate pathology:

• blueness around the mouth (cyanosis of the nasolabial triangle). Blue discoloration often appears when coughing, crying, screaming and disappears during periods of rest;
• fatigue, lethargy. This symptomatology is especially acute during intense physical activity;
• dizziness, loss of consciousness;
• poor body resistance to viral infections. Frequent colds;
• rapid heartbeat, shortness of breath;
• abnormal heart rhythm, heart murmurs;
• poor weight gain.

Diagnosis of the disease

Usually, a doctor can make a preliminary diagnosis after examining the baby and listening to the heart. Next, to accurately establish the pathology, an ultrasound of the heart is necessary (an ultrasound will show that the walls of the septum between the atria are thinned). If additional heart defects can be diagnosed by ultrasound, then it is necessary to additionally conduct transesophageal echocardiography (the exact volume of blood that is moving in the wrong direction is established), as well as an angiographic study.

These studies are carried out only in a specialized cardiology hospital. Such examinations make it possible not only to confirm the diagnosis of an open oval window in a newborn, but also to determine the degree of risk for the baby and find out how serious the disease is in this case. X-rays may also be needed to determine the boundaries of the heart and the thickness of the blood vessels.

Treatment method

Treatment of an open oval window in children directly depends on the size of the hole. If the hole does not exceed 3 mm, then usually no therapy is prescribed in this case. In a newborn, everything heals itself within a few months. The child is prescribed the usual restorative therapy (walks in the fresh air, moderate physical activity, proper nutrition).

You should take your baby’s daily routine seriously, without overloading him not only physically, but also psychologically. Your baby's diet should primarily include vegetables and fruits, as well as protein foods. If any infections are detected, it is necessary to begin treatment as quickly as possible, since any advanced disease puts a lot of stress on the heart.

If the dimensions of the open oval window are more than 3 mm, then in this case you will need to do an ultrasound every six months to monitor the dynamics. Additional medications may also be prescribed to improve the functioning of the heart muscle (panangin, L-carnitine analogues (Elcar)), and vitamins. If there is a risk of blood clots, your doctor may additionally prescribe blood thinners (anticoagulants).

The operation is indicated only in cases where the size of the open oval window in the child’s heart exceeds 7 mm, because of this the blood is thrown into the left side heart disease, which causes serious manifestations similar in severity to heart defects. In this case, only surgery is indicated to close the hole. In any case, it will not be possible to eliminate the problem with medication.

The surgical intervention involves inserting a special catheter through the artery. At the end of this catheter there is a special device that allows you to close the hole.

It is possible to determine exactly whether an operation is needed or not only by considering each specific case separately. To do this, it is important for the cardiologist to assess the size of the window, the characteristics of the patient’s heart, as well as the presence of additional diseases. Only after this can a final decision be made about the need for surgery.

Now a type of operation developed by London scientists is also beginning to be practiced, in which a kind of plaster is applied to the hole, which dissolves within a month, but at the same time completely eliminates the pathology.

Features of the operation

IN given time surgical intervention is performed exclusively by the endovascular method.

A special catheter is inserted through the artery on the right thigh, at the end of which there is an occluder - a device in the form of an umbrella, which opens in the right place and reliably plugs the hole, thereby eliminating the pathology.

Scheme of surgical treatment of an open oval window

The advantage of this operation is that there is no need to open the chest, stop the heart and use deep anesthesia. After surgery, antibiotics may be prescribed to prevent bacterial endocarditis.

Additional reasons when surgical intervention is required in any case:

• septal defect;
• heart defects;
• large hole size;
• valve is missing.

These are those cases when surgery most likely cannot be avoided.

According to statistics, an LLC that continues after the age of five is likely to accompany a person throughout his life. Often the window in a child’s heart does not have any special symptoms and doesn't interfere at all normal life person. Therefore, if a child does not want to engage in intense sports in the future, then a window will not interfere with him in everyday life.

But in the future, after 50 years, in the presence of concomitant diseases, this can complicate the course of diseases such as hypertension, heart failure, and also worsen the prognosis for recovery after heart attacks and strokes.

If the oval window does not close in a timely manner, then this is still not classified as a defect, but only as a feature of the development of the heart. At the same time, people with this pathology are advised to limit physical activity. It is also necessary to visit a cardiologist every six months and do a routine ultrasound.

There is no cause for concern if the baby does not have additional diseases (other heart defects, diseases of the pulmonary system, circulatory disorders).

This is due to the fact that an unclosed area of ​​the septum can only bother you if there are other provoking factors.

Also, if you have this pathology, it is prohibited:

• do weightlifting;
• scuba diving;
• dive to great depths from a springboard.

Girls may also experience problems with their heart function during pregnancy in the future.

Possible complications

Rare complications of this pathology may also include embolism. Emboli are small particles of fatty tissue, blood clots or gas bubbles. Under normal conditions, they are absent from the bloodstream, but in the event of chest injuries, fractures, or other problems, they can enter the bloodstream.

If there is an LLC, then they can enter the brain vessels through the left atrium through the veins and, clogging them, lead to the development of strokes and cerebral infarctions.

Although this is a rather rare problem, if a long course of treatment is necessary in the event of injuries or planned operations, it is necessary to warn the attending physician about this feature of the body.

Results and conclusions

To summarize, it is worth noting once again that prognosis and treatment methods directly depend on the presence of other provoking factors. Each case is individual and should be considered separately by a cardiologist.

But there is no particular cause for concern if there are no additional heart defects.

In most cases, this feature of the body is not a pathology and therefore does not require special treatment. Over time, the hole closes up on its own.

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