home Audience 6 The oval window in the heart did not close. What is an open foramen ovale in the heart in newborns, when should it close?

The oval window in the heart did not close. What is an open foramen ovale in the heart in newborns, when should it close?

A small diameter hole located between the left and right atria, the formation of which takes place in the womb, is called open oval window in newborns.

What is its meaning

LLC is a unique mechanism of a functional nature. Its essence lies in the fact that the fetal lungs are inactive and they do not need to be supplied large quantity blood. Oxygen-enriched blood enters the baby's body through the placenta from the mother.

If the foramen ovale does not close, the blood moves without affecting the pulmonary circulation. It goes directly to the large CC and the baby’s brain. This process is called shunting.

A patent foramen ovale in a newborn normally closes a few months after birth. The reason it closes is due to increased pressure levels in the left side of the heart.

According to statistics, in 10–25% of people the oval window remains open until they are 40 or more years old.

The reason for this is the structure of the window. It has a specific closing valve, which during systole of the left atrium closes the lumen in the window, thereby blocking the reverse flow of blood.

In some cases, the window remains open when frequent cough, sneezing or other types of overexertion. There are also cases when the reason for an LLC is elevated level pressure in the middle chest. There are frequent cases of keeping a window open due to structural damage.

A patent foramen ovale is a physiological pathology that closes a few months after the birth of a child.

Symptoms and danger of anomaly

In practice, if blood returns from the left atrium to the right through the OO window, this process occurs in a person without the manifestation of clear symptoms and does not cause him any discomfort.

When blood is directed from the right atrium to the left through an open foramen ovale into the heart of a child or an adult, this process is accompanied by the manifestation of some signs that may be permanent or transient:

blue discoloration of the skin;
violation of the structure or size of the left side of the heart;
development of symptoms of hypoplasia of the left heart;
paradoxical embolism;
signs of stroke;
symptoms of a transient attack.

Having a patent foramen ovale increases the likelihood of developing a stroke by 45–50%.

To anticipate this possibility, you need to pay attention to the following signs:

general weakness;
numbness of the upper or lower limb on one side;
weakness of vision or partial loss of vision;
loss of speech;
difficulty swallowing;
confused consciousness;
headache, often for no apparent reason;
loss of orientation in space;
development of uneven gait.

There are often cases when, in the presence of an open oval window, a condition such as hypoxia appears, which is accompanied by low level oxygen in the blood when a person is located in vertical position, as well as shortness of breath.

The cause of this syndrome is a violation of the process of blood distribution to the lungs.

If a child's oval window does not close before age 5, there is a good chance it will remain open throughout his or her life. However, such an anomaly will not affect his activity and health.

In the case when an LLC, which should normally be closed, is present in a person after the age of 40 or 50, he is likely to develop the following diseases:

hypertension;
ischemic BS;
chronic heart failure.

The presence of a patent oval window in people of different ages has different signs and consequences.

Diagnostics

The presence of this anomaly can be determined by regular listening. In this case, systolic murmurs are clearly audible in children.

To make a more accurate diagnosis, other methods are also used:

Ultrasound examination. The monitor will clearly show the presence of a violation of the structure of the heart.
Echocardiogram. This method makes it possible to obtain a two-dimensional image of the heart, on which the mechanism of its contraction will be clearly visible, as well as to find out the size of the oval window.
Transesophageal echocardiography. It is used if the patient has a concomitant disease such as heart disease. The essence of the method is introduction into the vessels through the esophagus. contrast agent.

If the diagnosis is confirmed, without the presence concomitant diseases, the child is registered at the dispensary.

The more methods used in diagnosis, the more accurate the diagnosis will be. The effectiveness of the treatment process depends on this.

Treatment

In the case where the oval window is not closed, but the patient does not have any complications of such an anomaly, drug therapy is not used.

For such a child, it is recommended to harden, alternate and balanced combination of physical activity and rest, stay on fresh air, dietary food, exercise therapy.

If the patient complains of pathological symptoms that are vague and irregular in nature, specialists prescribe a course of vitamins, as well as medicines, the action of which is aimed at providing additional nutrition to the heart muscle.

With the parallel development of an open foramen ovale and heart defects, experts give preference to correcting the defects through surgery. The essence of the operation is to insert a probe and a patch through the femoral vein, which closes the opening of the oval window.

If the work activity of patients with OO window is associated with a sedentary lifestyle (driver, programmer, pilot, etc.), they are recommended to take time off from work every 2–2.5 hours and take a short walk, preferably in the air.

This will help avoid blood stagnation and the formation of blood clots in the veins of the upper or lower extremities.

Prescribing an effective course of treatment provides a patient diagnosed with OO with a long and active life. Be healthy!

The news that a patent foramen ovale has been discovered in a child’s heart puts his parents into a state of fear. This pathology has become especially common lately. Is there a danger of such a pathology?

Features of OO windows

A patent foramen ovale is an open hole located in the septum separating the left and right atria. With normal development of the cardiovascular system, the window closes completely approximately 1 year after the baby is born.

During intrauterine development, the lumen of the window is covered with a specific valve. Until the moment of birth, it fully matures. When a baby takes its first breath after birth, its lungs open, resulting in increased pressure levels in the left atrium.

As a result, complete closure of the oval window occurs by complete attachment of the valve to the septum between the atria.

According to statistics, in approximately 50% of newborns, the oval window closes within a year. In some cases - by 4–5 years.

If the interatrial valve is small in size, then after birth the hole does not close completely. As a result, the left and right atria are not isolated from each other. This gives every reason to make a diagnosis that the child has a patent foramen ovale.

Cardiologists classify this condition as a simple heart pathology. If the child does not show any symptoms of pathology and is able to grow and develop normally, LLC is regarded as individual structure hearts.

A patent foramen ovale is an opening in the septum of the two atria. At the moment of contraction of the heart muscle, blood flow through the window can flow from one atrium to the other.

Causes

As shown medical practice, one of the main reasons that leads to the fact that the oval window remains unclosed is genetic disposition. As a rule, the predisposition tends to be transmitted to the child through the mother.

In addition, other reasons should also be highlighted:

the baby is born premature;
development of dysplasia connective tissue;
Congenital heart defect;
the mother abuses alcohol or takes drugs;
the expectant mother smokes during pregnancy;
During the first months of pregnancy, a woman takes medications that provoke toxic poisoning baby;
poor nutrition of a pregnant woman;
influence of negative environmental factors;
frequent stress.

Often, an open foramen ovale tends to appear as the child develops various kinds heart defects:

open aortic duct;
congenital tricuspid or mitral PS.

Among the factors that can trigger the development of an LLC are the following:

frequent physical activity on the body of a pregnant woman;
thromboembolism of the pulmonary artery.

If there is one or another factor during pregnancy that can provoke the development of such a pathology, you should inform your doctor about it.

Symptoms

In most cases, a pathology such as patent oval window occurs without any symptoms. It is also possible that the signs appear rather weakly.

If we talk about the symptoms of pathology in children, we can highlight the following:

cyanosis of the skin surface;
pallor of the area around the lips, which is observed during slight stress of the body;
frequent colds;
diseases of the bronchi or lungs;
slow weight gain.

If we talk about older children, they may exhibit the following signs:

rapid fatigue during heavy physical exertion;
dyspnea;
frequent pulse.

Experts believe that if the oval window is not overgrown before the age of 5, most likely this will not happen in the future. The child will have to live with this heart pathology for the rest of his life.

IN at a young age, the anomaly may not cause any inconvenience at all. But after 45–50 years, there is a high probability that the presence of an open oval window can aggravate any existing problems in a person. cardiovascular diseases.

Possible consequences and treatment

If the oval window remains unclosed, the development of any complications is observed in extremely in rare cases. Among the most common are the following:

People with an LLC have fairly favorable prognoses for the future.

To avoid the development of complications, you should adhere to the following recommendations:

periodically undergo a medical examination by specialists, which includes an echocardiogram;
limiting heavy physical activity;
class professional activity which does not involve heavy physical activity or nervous strain;
Avoid extreme sports.

If the pathology is not accompanied by symptoms and does not affect the normal state of health and life of the child, it is not recommended to carry out any treatment.

In the same case, when the closing valve does not completely close the oval window, which leads to the development of diseases such as stroke in the child, ischemic disease heart disease or heart failure, experts prefer a preventive course of treatment.

Its main focus is the prevention of thromboembolic complications.

For this, Aspirin or Warfarin is usually used.

TO surgical treatment resort only if the blood discharge reaches a large volume. As a rule, a low-traumatic operation, X-ray endovascular occlusion of the LLC, is performed.

If the pathology of the open oval window is detected in a timely manner, as well as if all recommendations of specialists are followed, this anomaly does not pose any threat to the child’s life.

Any problems with a child’s heart frighten parents and cause anxiety, especially if they are congenital defects. However, among cardiac pathologies in childhood there are also very serious ones, life threatening, and not so dangerous, with which a child can live quite normally. The latter also includes the open oval window (abbreviated as OOO).

Patent foramen ovale - not so much terrible diagnosis for the child and his parents

What is this

This is the name given to the structural feature of the septum inside the heart, which is present in all children during intrauterine development and is often detected in a newborn. The thing is that the heart of a fetus functions somewhat differently than that of an infant or an adult.

In particular, in the septum separating the atria there is an opening called the oval window. Its presence is due to the fact that the fetal lungs do not work, and therefore little blood enters their vessels. The volume of blood that in an adult is ejected from the right atrium into the veins of the lungs, in the fetus passes through the hole into the left atrium and is transferred to the more actively working organs of the baby - the brain, kidneys, liver and others.

This window is separated from the left ventricle by a small valve that matures completely by the beginning of labor. When the baby takes his first breath and his lungs open, blood flows into them, which is accompanied by an increase in pressure inside the left atrium. At this moment, the oval window is closed by the valve, and then it gradually fuses with the septum. If the window closes prematurely, while still in utero, this threatens heart failure and even the death of the child, so the presence of an opening is important for the fetus.

The window between the atria can close even by age 5

Closing the window occurs differently for different children. In some, the valve grows to it immediately after birth, in others - during the first year, in others - by the age of 5. In some cases, the size of the valve is not sufficient to close the entire oval window, which is why the hole remains slightly open for life, and a small volume of blood is periodically discharged from the small circle into the big circle blood circulation This situation is observed in 20-30% of children.

A foramen ovale that does not close completely after birth is not considered a defect in the septum that divides the atria, since the defect is a much more serious problem. It is considered a congenital defect, and LLC is classified as a minor anomaly, representing only an individual feature. With a septal defect, the valve is completely absent and blood can be discharged from left to right, which poses a health hazard.

LLC, not closed over time, refers to congenital heart defects

Causes

Most often, an unclosed foramen ovale in the heart of a child is associated with a genetic predisposition, which in most cases is transmitted from the mother. Other reasons for the appearance of LLC are adverse effects during gestation:

Quite often, non-closure of the oval window is noted in children born much earlier. ahead of schedule, as well as in the presence of intrauterine growth retardation in full-term babies.

In the following video you can see how a child’s blood circulation and heart activity should normally change before birth.

Symptoms

If the open valve is an isolated problem and the child has no other heart defects, clinical picture quite meager. You can suspect LLC in an infant by:

Detection of rapid heartbeat.
Changes in the color of the nasolabial triangle (it becomes blue or gray) during feeding or crying.
Shortness of breath.
Poor appetite.
Small weight gain.

In preschoolers and children school age there may be problems with exercise tolerance and frequent inflammatory diseases respiratory system.

A schoolchild with LLC gets tired quickly and needs a strict daily routine with alternating loads and rest

IN adolescence when the body is actively growing and hormonal changes, LLC in children manifests itself:

Weakness.
Feelings of interruptions in heart rhythm.
Increased fatigue.
Episodes of dizziness.
Periodically occurring causeless fainting.

Diagnostics

You can suspect that your baby has a PFO after listening to the heart with a stethoscope. If the doctor hears systolic murmurs, he will order an ultrasound for the child, since this is the most preferable method for identifying the oval window. Pathology is often detected during routine echocardiography performed on all children at 1 month. In some cases, to clarify the problem, the baby may be prescribed a transesophageal ultrasound, as well as angiography.

Ultrasound signs of an open oval window are:

Size up to 5 mm.
Position in the middle part of the septum.
Inconsistency in visualization of the hole.
Detection of a valve in the left atrium.
Thinned interatrial septum.

You can see what an LLC looks like on an ultrasound in the following video.

Komarovsky's opinion

A well-known pediatrician confirms that the oval window is open in almost all newly born babies and in 50% of them remains open until the age of 2. But even at the age of 2 to 5 years, the presence of such a window in the heart is considered a variant of the norm, which has practically no effect on the well-being and health of the child.

Komarovsky emphasizes that this is not a heart defect and in most children the window closes on its own in the first years of life without any intervention from doctors.

Treatment

If there are no obvious symptoms and problems with the functioning of the heart, which is especially often the case in the presence of PFO, no drug treatment is required. The child is recommended to take measures that are important for general strengthening body:

Walks in the open air.
Balanced diet.
Proper distribution of loads and rest during the day.
Hardening procedures.
Physiotherapy.

If there are complaints from the heart, children are prescribed drugs to nourish the myocardium and vitamins. Most often, children are prescribed l-carnitine, ubiquinone, panangin and magne B6.

The most effective treatment LLC is the introduction of a patch into the right atrium

If LLC is combined with other defects, the child is treated by a cardiac surgeon, since surgery is often required. One of the effective measures for an open oval window is the introduction of a probe with a patch into the femoral vein of the child. When the probe reaches the right atrium, a patch is applied to the window and closes it. While it dissolves within a month, the formation of connective tissue in the septum is activated, as a result of which the oval window closes.

Forecast

Many parents worry that the “hole in the heart,” as they call it, will endanger the child’s life. In fact, this problem is not dangerous for the baby and most children with an open window feel quite healthy. It is only important to remember some restrictions, for example, in relation to extreme sports or professions in which the load on the body increases. It is also important to have your baby examined by a cardiologist every 6 months with an ultrasound examination.

If the foramen ovale remains open after the child's fifth birthday, it is most likely that it will not heal and will be with the child for the rest of his life. Moreover, such an anomaly has almost no effect on work activity. It will become an obstacle only to obtaining the profession of a diver, pilot or astronaut, as well as to strong sports loads, for example, weightlifting or wrestling. At school, the child will be classified in the second health group, and when conscripted, a boy with LLC will be counted in category B (there are restrictions during military service).

Many children with LLC feel quite healthy

It is noted that at the age of over 40-50 years, the presence of PFO contributes to the development of ischemic and hypertension. In addition, during a heart attack, an unclosed window in the septum between the atria negatively affects recovery period. Also, adults with an open window experience migraines more often and often experience shortness of breath after getting out of bed, which immediately disappears as soon as the person goes back to bed.

Among the rare complications of PFO in childhood, embolism may occur. This is the name for the entry into the bloodstream of gas bubbles, particles of adipose tissue or blood clots, for example, during injuries, fractures or thrombophlebitis. When emboli enter the left atrium, they travel to vessels in the brain and cause brain damage, sometimes fatal.

It happens that the presence of a patent foramen ovale helps improve health. This is observed during primary pulmonary hypertension, at which due to high pressure shortness of breath, weakness, chronic cough, dizziness, fainting. Through the oval window, blood from the small circle partially passes into the large circle and the vessels of the lungs are unloaded.

You can learn even more about the open oval window from the following video.

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 the 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 the pulmonary vessels increases. As a result, the main role of the oval window is to drain blood into left half hearts are leveled.

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:

Unfavorable environment;
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. Moreover, taking NSAIDs is dangerous in late gestation, which is the reason why the oval window did not close;
Drinking alcohol and smoking during pregnancy;
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 clinical signs may be practically no different from 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?

For a small oval window external manifestations may be missing. 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:

Physical activity that is fraught with an increase in pressure in the pulmonary vessels (long-term breath holding, swimming, diving);
Heavy physical work (weightlifting, acrobatic gymnastics);
For lung diseases (bronchial asthma, cystic fibrosis, emphysema, pulmonary atelectasis, pneumonia, with hacking cough);
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 delay 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:

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.
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.
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 for obese patients, when visualization of anatomical structures is 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?

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.
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.
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

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 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 performing any surgical interventions in patients with an open oval window, 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 are especially important). 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:

Medicines containing magnesium (“Magne-B6”, “Magnerot”);
Drugs that improve the conductivity of nerve impulses (Panangin, Carnitine, B vitamins);
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 the initial level by 40%;
The growing uterus begins to take up most of the 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 - the placental-uterine circulation.

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.

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.

Particularly noteworthy is the presence of a large oval hole, which is essentially an analogue of a defect interatrial septum. 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. The oval window in the heart is 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 hereditary factor and, in extremely 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 constant illnesses lungs, vein thrombosis, other cardiac disorders, as well as pregnancy 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 therapeutic techniques when identifying a 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

At characteristic features pathologies are carried out 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.

boost immune protective functions the body due to hardening;
accept cold and hot shower to stimulate the heart;
organize walks in the 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 dishes instant cooking from the supermarket;
engage in physical therapy.

An open foramen ovale in the heart can affect the cardiovascular system, causing organ conduction disturbances and sudden surges in 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 medicines, improving interaction between the chambers of the heart;
tablets that stimulate the production of energy in the pinpoint regions of the heart.

If the opening is large and blood flow is formed in the left atrium, surgical intervention is indicated, in anticipation of which thrombosis is prevented. 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 physical exercise, do not dive under water and try to fly less by plane. 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 conduct full image life and after some time they can forget about previous restrictions in their lifestyle. 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 the structural features of the heart, and not 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:

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 species sports and eating right in the presence of such an anomaly, then you can feel quite 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, the future baby receives a complex 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 recent years, a patent window has often been 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. It is very important to monitor a 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 physiological feature 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 the responsibility of an experienced specialist, who takes into account a number of signs 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 individual characteristics 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

It is not uncommon to suspect the presence open window A routine physical examination by a specialist allows. It detects cyanosis 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).

Install accurate diagnosis instrumental diagnostics allows:

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 carrying out the necessary research will allow you to exclude such developments. 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, you should avoid any contact with chemicals(paints, varnishes, dangerous drugs) and ionizing radiation. 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. There is no need to scare him with medical terms and show excessive concern about health. 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 oxygen enrichment of the brain, but in in good condition 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, there can be no serious consequences 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;
disturbed heartbeat, 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 is special device, allowing 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.

Injected through the artery on the right thigh special catheter, 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, a window in a child’s heart does not have any special symptoms and does not interfere with 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 has no 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 fairly rare problem, it still requires a long course of treatment in case of injury 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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During the process of intrauterine development, some “imperfections” of embryogenesis are often observed. Such deviations are referred to as minor anomalies (MARS).

They are not regarded as congenital malformations. One of the widely diagnosed variants is the patent oval window (PFO).

Normal blood circulation in the fetus and newborn

Open oval window in the heart - natural anatomical structure during intrauterine development.

In the fetus, only the systemic circulation functions. The small circle is closed due to the lack of breathing through the lungs.

The consequence of this is the exclusion of the right ventricle and left atrium from the work of the cardiovascular system. Therefore, the body responds temporarily defensive reaction in the form of an LLC.

Localization of this structure – middle part interatrial septum. The window begins to open at 3 weeks, when the heart begins to beat. Its dimensions do not exceed 0.5 cm.

Anatomically, in this place there is an oval fossa, in which there is an opening for the reverse discharge of blood. The distinctive part of this formation is the closing valve.

He plays important role in the further formation of normal blood circulation.

After the baby is born, the lungs begin to function at the first cry. At the same time, the pulmonary circulation is turned on.

Due to a sudden and sharp increase in pressure in the left atrium, the valve of the foramen ovale closes. The communication between the cavities disappears.

If there is a deviation during this process, then a functioning oval window is formed after birth. This anomaly is not classified as a defect due to its favorable prognosis. It closes by age 2 in most children.

Reasons for formation

The exact etiological factors contributing to the timely failure to close the oval window are not completely known. However, doctors note a higher percentage of detection of such an anomaly if there were possible causes:

From the mother's side:
hereditary nature of the minor anomaly;
difficult pregnancy (preeclampsia, frequent infections, threats of miscarriage);
alcohol abuse;
smoking;
diffuse connective tissue diseases;
radiation and radiation exposure;
chronic diseases that worsen the course of pregnancy (diabetes mellitus).
From the fetus:
prematurity;
individual anatomical features - the oval valve is small in size;
congenital defects and deformities;
chronic hypoxia;
lung pathology, including pneumonia of newborns.

Thus, the formation of an open window occurs in two ways:

The discrepancy between the small dimensions of the valve and the larger diameter of the hole when it “slams shut”.
Insufficient pressure in the vessels of the pulmonary circulation and the left atrium, which is accompanied by a lack of valve closure.

If LLC is formed along the 1st path, then such a small anomaly persists for many years, right up to old age. In case 2, spontaneous closure occurs in childhood.

Clinical picture

For many years, the oval window in the heart can be asymptomatic. You can suspect an anomaly in a newborn and older children based on the following signs:

weak sucking reflex;
small weight gain;
excessive regurgitation;
blueness of the nasolabial triangle during crying, straining, coughing, defecation;
some delay in physical development;
frequent respiratory infections;
fast fatiguability;
shortness of breath when exercising physical culture At school;
decreased exercise tolerance.

During pregnancy, a functioning open foramen ovale is accompanied by:

frequent changes in blood pressure;
heartbeat;
interruptions in heart function;
shortness of breath with minimal exertion;
recurrent acute respiratory infections.

An adult without concomitant diseases has no complaints. Symptoms occur during severe physical and emotional stress.

In such cases, the patient with a functioning oval window is concerned about:

long-term shortness of breath at rest;
heartbeat;
chest discomfort;
piercing pains in the region of the heart;
increased blood pressure;
blueness of lips.

The patient usually does not pay attention to these symptoms due to the fact that they pass quickly. In such cases, PFO is often a finding in diagnostic searches for other diseases.

Methods for detecting minor cardiac anomalies

After the baby is born, he is examined by a neonatologist in the first days of life. At the same time, the following are of medical interest:

mother's complaints about changes in skin color and problems with breastfeeding;
the nature of the ongoing pregnancy;
hereditary history;
weight gain curve;
during physical examination - auscultation of the heart and lungs;
data from additional studies.

When an adult visits a doctor, the following is also carried out:

Collection of complaints and anamnesis of life, illness.
Objective examination.
Laboratory tests.
Instrumental research methods:
Ultrasound of the heart;
Holter monitoring;
pulse oximetry (determining the degree of blood oxygen saturation);
X-ray of the chest organs.

Upon objective examination experienced specialist may suspect a diagnosis of an oval patent window during auscultation of the heart due to additional noise, changes and accentuation of tones on the pulmonary artery. Often in such cases there is a displacement of the apical impulse.

From laboratory research prescribe:

Complete blood count to detect erythrocytosis (increased number of red blood cells due to blood thickening).
Biochemical study to determine the functioning of the kidneys, liver, lipid spectrum.

ECG and its daily monitoring are carried out to assess possible violations rhythm and to identify ischemic disorders during exercise.

The only method that makes it possible to make a final diagnosis with an open foramen ovale is ultrasound of the heart.

At the same time, its size and signs of pulmonary hypertension are assessed. If a developmental anomaly is suspected, a study is prescribed from the first days of life.

Lead tactics

If a patent oval window is detected without pronounced clinical symptoms, doctors take a wait-and-see approach.

Children with this diagnosis are registered with a cardiologist, where an individual schedule for visiting a specialist and a research plan are drawn up. It explains to parents what MARS is and why it is important not to miss visits to the doctor.

For an open oval window measuring 2 mm or less, no medications are prescribed. The prognosis for such patients is favorable. In children, the formation of adult-type blood flow occurs by the age of 6 years.

By this time, in most cases, the closing of the window is noted. Treatment is usually not carried out. After the closure of the LLC, sports are not contraindicated.

If a newborn has a PFO of more than 3 mm, then at the age of 1 and 3 months. A visit to a cardiologist is indicated. In the absence of clinical symptoms, a further visit is scheduled at 1 year. During it, the dynamics of closing the LLC are assessed.

When a child has a large hole, severe symptoms and rhythm disturbances, surgical treatment is recommended.

If detected during pregnancy and in adulthood in the heart of an open foramen ovale, dynamic observation is indicated. If necessary, supportive and symptomatic drug therapy is prescribed.

Treatment options

In most cases, medical intervention is not required for PFO. However, in any case, treatment begins with general recommendations:

Limiting heavy physical activity.
It is prohibited to engage in professional sports.
Eating healthy and maintaining ideal body weight.
Elimination of bad habits: smoking, alcohol, strong coffee.
For children on artificial feeding– mixtures with increased calorie content.
Control for blood pressure and heart rate.
Reducing stressful and psycho-emotional situations.

The following medications may be prescribed by your doctor as maintenance therapy:

Symptomatic treatment includes prescription:

antiarrhythmics;
blood pressure-normalizing drugs;
medications for blood thinning during thrombosis and thromboembolism - anticoagulants, disaggregants.

Surgical treatment is indicated at any age with gross violations hemodynamics, high risk of complications and severe clinical picture.

The essence of the operation is that the defect is closed with a special patch.

The intervention was well tolerated. It is carried out percutaneously - through the femoral or radial artery using a special probe with the introduction of a contrast agent. Complications are rare. After the operation, the patient is allowed to play sports.

LLC is not a congenital heart defect (CHD). The prognosis for life and work ability with such an anomaly is favorable. There is no need to treat it. The main thing is to visit a specialist for dynamic monitoring in order to prevent the development of undesirable consequences.