home Audience 6 Open oval window in children. Open foramen ovale in the heart in children

Open oval window in children. Open foramen ovale in the heart in children

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?

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. More often this pathology caused by non-steroidal anti-inflammatory drugs (NSAIDs). It has been proven that these drugs cause a decrease in the level of prostaglandins in the blood, which are responsible for the closure of the oval window. However, taking NSAIDs is dangerous late dates 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, 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 infants with an open oval window, it is typical:

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 an ultrasound examination of the heart, performed not through the chest, but the 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 x-ray of the organs are possible chest(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 is possible 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 through the foramen ovale. big circle blood circulation 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 arterial 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.

Currently, endovascular surgery has become widespread.

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

endovascular closure of the oval window in the heart

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

Disease prognosis

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

Pregnancy and childbirth in women with the defect

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

The volume of circulating blood increases, by the end of pregnancy it exceeds baseline by 40%;
The growing uterus begins to 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 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.

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 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 can be diagnosed at an older age with acquired disabilities of cardio-vascular 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.

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

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

increase the immune protective functions of the body through 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;
consume only healthy foods in food excluding fried meat, canned drinks and fast food from the supermarket;
engage in physical therapy.

A patent foramen ovale in the heart can affect the 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 medicines, improving interaction between the chambers of the heart;
tablets that stimulate the production of energy in the pinpoint regions of the heart.

At large sizes openings with the formation of blood flow in the left atrium are shown 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. The operation is recommended only in complex cases, when the size of the gap portends complications and is considered 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 cell walls, blood vessels and leading 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 cerebral blood supply, in which motor and auditory functions are damaged and memory impairment 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 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 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:

When serving in the armed forces, conscripts are required to perform vigorous physical activity every day. Since the number of deaths in the army has increased, and the main reason for this is heart disease, medical examination has begun 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 complex of necessary nutrients from the 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 a patent window was often 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 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 issue of the need for surgical treatment is decided.

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, when crying or straining for a long time, the hole swings open, allowing no a large number of blood from one atrium to another.

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 organism, 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 is a 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 You should lead a healthy lifestyle, 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;
Together with your doctor, develop the right diet;
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 an 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;
weak resistance of the body 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. The baby's diet should first of all include vegetables and fruits, as well as protein food. If any infections are detected, it is necessary to begin treatment as quickly as possible, since any advanced disease puts a strong strain 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 the window in a child’s heart does not have any special symptoms and does not interfere with normal human life. 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 on greater depth from the 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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All questions regarding the structure of the baby’s heart raise many questions and fears among parents, because the heart is the basis of life, along with the brain, and if there is a defect in it, even a small one, this greatly frightens parents. Often, after an ultrasound examination of the heart in conclusion, the doctor writes a diagnosis of “patent foramen ovale or oval”, and parents believe that the child has a heart defect, panic and begin to frantically run to doctors and search through the groans of information. Today, on average, up to 70% of babies receive such a conclusion in the first month of life, but what is this window and why is it open?

Fetal circulation
During gestation, the cardiovascular system develops early, the heart is formed already at three weeks, and at five or six it is clearly visible on ultrasound due to its rhythmic contractions. Of course, it is still developing and forming, but it already copes with its main function, driving blood through the vessels. In the prenatal period, the blood circulation of the fetus is special, since the lungs are turned off because they do not breathe. In addition, the blood circulation of the fetus is closely connected with the vessels of the placenta and mother, although they do not mix and each has its own blood. To provide oxygen to the growing brain and body, but to carry out blood circulation without the participation of the lungs (while their function is performed by the placenta), a special structure of the heart is needed.

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Therefore, the blood in the heart passes through bypass routes, bypassing the pulmonary circulation, and therefore there are several additional openings in it - the ductus ductus and the oval window. Blood flows from the heart through the duct, bypassing pulmonary vessels into the aorta, and through the oval window it is discharged from the right atrium to the left, again due to the fact that the lungs are turned off from breathing. If this hole did not exist, the right parts of the heart would be overloaded and the child would not be able to survive in the womb. Blood from the right parts of the heart nourishes the brain and head area, giving them the opportunity to grow and develop, while the left parts “feed” the rest of the body.

At the birth of a baby, the child’s blood circulation fundamentally and dramatically changes, the ductus ductus and the open oval window lose their relevance, therefore, they must become obliterated (in other words, close) and the blood circulation will be rebuilt to a new, already “adult” type. This occurs due to the expansion of the lungs, breathing, the first cry and the activation of the system of pulmonary veins and pulmonary arteries. Do you remember that in the lungs everything is the other way around - through the veins blood comes from the lungs, and it is arterial, and the pulmonary artery collects from the whole body venous blood and enriches it with oxygen in the lungs. Due to changes in pressure in the left atrium, the oval window is closed with a special valve like a door and the edges of the valve adhere tightly to the hole.

Usually this happens in the first day of life, functional closure occurs - that is, the door closes, but its complete overgrowth and the formation of a full-fledged interatrial septum occurs in different time– from two months to a year. Sometimes this happens longer, up to two to five years. This is quite normal phenomenon. However, not all children have a window that closes completely on the first day of birth. It may turn out to be slightly larger than the valve, it may not fit tightly, which is why this peculiar defect is formed - an open oval window.

Reasons for the formation of LLC.
Underdevelopment of the valve and an open oval window occurs most often in premature babies, but it can also occur in full-term babies. Reasons this phenomenon consider disturbances during pregnancy - threats of miscarriage, toxicosis, fetal hypoxia. In addition, the risk of getting OOO is higher in women who smoke and took alcohol before pregnancy. In addition, the development of an open window is also facilitated by unfavorable ecology, stress during pregnancy, and the influence of heredity.

As a result, the normal development of the valve in the area of the oval window is disrupted; it does not have time to grow to the size of the oval window itself, and as a result, at the moment the baby takes his first breath and his pulmonary circulation begins to function, he is simply unable to cover the hole completely. However, an open oval window also occurs with more serious problems rather than just a functional defect. Sometimes, with diseases that overload the right chambers of the heart, the window will not close to alleviate the condition - it acts as a relief hole, due to which part of the blood is removed and reduces the pressure in the chamber. This occurs with the development of primary (as a heart defect) or secondary (as a result of disease) pulmonary hypertension, with pulmonary artery stenosis (a heart defect), with an abnormal structure of the pulmonary veins or malformations of the heart valves. These are all cardiac supports in which a patent foramen ovale occurs.

How does this condition manifest itself?
Despite the small size of the defects, this is a completely normal child with no defects. this state is not considered, therefore it will not have any manifestations. OOO is detected during routine ultrasound examinations, which are provided to all children under one year of age as part of the birth certificate. However, with sufficiently large defects, there are some small symptoms that give the doctor the right to suspect this defect. These include:

Cyanosis of the nasolabial triangle or lips with strong crying, screaming, physical exertion or activity. When alone, it disappears and the child behaves as usual.
- frequent colds, frequent pneumonia or bronchitis.
- some slowdown in mental or physical development compared to peers.
- listening to a heart murmur
- systematic attacks of loss of consciousness, manifestation of symptoms of the disorder cerebral circulation
- inability to exercise, fatigue, development of a feeling of shortness of breath.
The last three signs occur when the defects are quite large. If the doctor suspects that the child has an unclosed oval window, he will send him for a consultation with a cardiologist and an ultrasound.

What do we have to do?
When making a diagnosis of “patent foramen ovale”, it is necessary to resolve the issue of further actions parents, pediatrician and possibly a cardiologist. First of all, defects up to 4-5 mm in size should not cause any concern, since they generally close quickly and easily in the first months of life. They only require observation by a cardiologist and periodic ultrasound examinations. Parents will simply observe the well-being and condition of the baby and the pace of its development; usually all this goes well and does not require intervention at all.

With larger window sizes, approximately once every six months to a year you will undergo a heart ultrasound to determine the size of the defect. If it tends to decrease, the doctor will also suggest that you wait and do nothing; the likelihood of spontaneous healing of the defect is very high. In addition, the pressure in the area of the left atrium is always higher than in the right and blood through the open oval window simply will not flow into the area of higher pressure, and the valve will press tightly, plus, due to muscle contractions of the walls, the defect will decrease. Therefore, for defects of five to seven millimeters, only active monitoring of the defect is necessary.

At the same time, in newborns and children, the defect will appear only when straining, anxiety, when blood pressure in the right side of the heart increases. In older children this may occur when severe cough, exercises with straining and holding your breath, diving. Therefore, most likely the doctor will not allow such a child to swim, engage in weightlifting, or choose professions related to extreme sports - diver, pilot, miner.

If the size of the defect is more than 7-10 mm, disorders typical of a heart defect may appear - ASD - atrial septal defect. Such an open oval window is called gaping. Then the child must be consulted with a cardiac surgeon and decide on surgery to correct the septum. A catheter with a special plate, an occluder, is inserted through the femoral vein; it closes and welds the hole.

The greatest danger of the oval window is the possibility of developing a paradoxical embolism in it - through the defect, the embolus penetrates into an unusual area - the vessels of the head. Fortunately this rarely happens.

So, conclusions.
The diagnosis of “ooo” is not a heart defect, its size is up to 7 mm and it does not require heart surgery. It does not disrupt the child’s life and does not affect his health, provided normal image life without extreme sports such as climbing Everest or scuba diving for six months.
The defect is permissible up to two years; in 90% it closes in the first months of life. However, in some children it can persist for up to five years, without affecting growth and development in any way. Children at OOO lead a normal child’s life, there is no need to fuss over them and blow off specks of dust from them, but you shouldn’t give them to three sections at once either - it is necessary to dose the loads and not overload the baby.

OOO requires regular examinations and ultrasounds, but it is enough to carry them out once every six months; it is not advisable to do ultrasounds more often - this is unnecessary stress for the child and the results are not indicative.

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

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

What is a patent foramen ovale in the heart?

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

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

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

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

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

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

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

Reasons why the oval window does not close

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

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

smoking and use of chemicals by the mother during pregnancy,
underdevelopment of the valve due to premature birth of a child,
genetic predisposition,
connective dysplasia.

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

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

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

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

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

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

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

Features of blood circulation with a functioning open oval window

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

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

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

violation of the pressure of the valve closing the window, with its slower growth relative to the entire heart;
concomitant diseases characterized by increased pressure in the right atrium. In this case, the pressure on the valve from the side of this atrium becomes higher than from the part of the left one, the pressure on the valve weakens and the window opens mechanically.

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

chronic lung diseases,
leg vein diseases,
combined heart pathology.

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

In such cases, constant medical supervision is necessary.

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

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

Symptoms and diagnosis

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

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

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

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

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

Treatment of an open oval window in the heart

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

Among the treatment methods pathological cases is also listed surgery.

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

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

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

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

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

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

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

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

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

Complications, consequences

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

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

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

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

– incomplete closure of the foramen ovale in the interatrial septum, which normally functions during the embryonic period and closes in the first year of the child’s life. An open foramen ovale can be manifested by cyanosis of the nasolabial triangle, slow physical development, shortness of breath and tachycardia, sudden fainting, headache, frequent acute respiratory viral infections and bronchopulmonary diseases. Diagnosis of an open foramen ovale includes an ECG (at rest and after exercise), conventional and Doppler echocardiography, radiography, and probing of the cardiac cavities. With an open foramen ovale, anticoagulant therapy can be used, and, if necessary, surgical treatment (endovascular occlusion of the defect).

Causes of a patent oval window

All children are born with a patent foramen ovale. After the first independent breath, the newborn’s pulmonary circulation turns on and begins to fully function, and there is no need for an open foramen ovale. An increase in blood pressure in the left atrium compared to the right leads to the closure of the oval window valve. In most cases, the valve closes tightly and is completely overgrown with connective tissue - the open oval window disappears. Sometimes the hole closes partially or does not close at all, and under certain conditions (during excessive coughing, crying, screaming, tension in the anterior abdominal wall), blood is discharged from the right atrial chamber to the left (functioning oval window).

The reasons for incomplete closure of the oval window are not always clear. It is believed that a hereditary predisposition, prematurity, congenital heart defects, connective tissue dysplasia, and exposure to adverse factors can lead to an open foramen ovale. external environment, smoking and drinking alcohol by a woman during pregnancy. Due to genetic characteristics, the diameter of the valve may be smaller than the diameter of the oval opening, which will prevent its complete closure.

A patent foramen ovale may be accompanied by congenital defects of the mitral or tricuspid valves, or a patent ductus arteriosus.

Risk factors for the opening of the oval window valve may include significant physical activity in athletes involved in weightlifting, wrestling, and athletic gymnastics. The problem of an open oval window is especially pressing for divers and divers who dive to significant depths and have a 5 times higher risk of developing decompression sickness. In patients with thrombophlebitis of the lower extremities or pelvis with a history of episodes of pulmonary embolism, contraction of the pulmonary vasculature can cause increased pressure in the right side of the heart and the appearance of a functioning patent foramen ovale.

Features of hemodynamics with an open oval window

The open foramen ovale is located at the bottom of the fossa oval on the inner left wall of the right atrium, often has a small size (about the size of a pinhead) and a slit-like shape. The size of a patent oval window averages 4.5 mm, but can reach 19 mm. An open foramen ovale, in contrast to an atrial septal defect, has a valve structure that ensures the variability of interatrial communication and the ability to discharge blood in only one direction (from the pulmonary circulation to the large one).

The clinical significance of a patent foramen ovale is controversial. A patent foramen ovale may not cause hemodynamic disturbances and may not have negative impact on the patient’s health due to its small size and the presence of a valve that prevents blood from shunting from left to right. Most people with a patent foramen ovale are unaware of this anomaly and lead normal lives.

The presence of a patent foramen ovale in patients with primary pulmonary hypertension is considered prognostically favorable in terms of life expectancy. However, excess pressure in the right atrium compared to the left with an open foramen ovale leads to the periodic occurrence of a right-to-left shunt, which allows a certain volume of blood to pass through and leads to hypoxemia, transient cerebrovascular accidents (TIA), and the development of life-threatening complications: paradoxical embolism, ischemic stroke , myocardial infarction, kidney infarction.

Symptoms of an open oval window

A patent oval window does not have specific external manifestations; in most cases it occurs latently, and can sometimes be accompanied by scant symptoms. Indirect signs an open oval window may be: severe pallor or cyanosis of the skin in the area of the lips and nasolabial triangle during physical stress (crying, screaming, coughing, straining, bathing a child); tendency to frequent colds and inflammatory bronchopulmonary diseases; slower physical development of the child (poor appetite, insufficient weight gain), low endurance during physical activity, combined with symptoms of respiratory failure (shortness of breath and tachycardia); sudden fainting and symptoms of cerebrovascular accident (especially in young patients, with varicose veins, thrombophlebitis of the lower extremities and pelvis).

Patients with a patent foramen ovale may experience frequent headaches, migraines, postural hypoxemia syndrome - the development of shortness of breath and decreased saturation arterial blood oxygen in a standing position with improvement when moving to horizontal position. Complications of a patent oval window occur rarely. Paradoxical embolism of cerebral vessels, aggravating this anomaly, is characterized by the sudden development of neurological symptoms and a fairly young age of the patient.

Diagnosis of an open oval window

Studying the medical history and physical examination of the patient often does not immediately allow one to determine the presence of an open foramen ovale, but can only assume the possibility of this anomaly of the interatrial septum (cyanosis of the skin, fainting, frequent acute respiratory viral infections, developmental delay in the child). Auscultation helps identify the presence of a heart murmur as a result of an abnormal shunt of blood from a chamber with more high pressure into a low pressure chamber.

To establish an accurate diagnosis of an open oval window, instrumental studies and visualization methods: ECG (at rest and after exercise), conventional and Doppler echocardiography, chest radiography, probing of the cardiac cavities.

When the foramen ovale is open, changes appear on the electrocardiogram indicating an increased load on the right parts of the heart, especially on the right atrium. In older people with a patent oval window, radiological signs enlargement of the right chambers of the heart and increased blood volume in the vascular bed of the lungs.

In newborns and young children, transthoracic two-dimensional echocardiography is used, which makes it possible to visually determine the presence of an open oval window and its diameter, obtain a graphic image of the movements of the valve leaflets over time, and exclude an atrial septal defect. Doppler echocardiography in graphical and color mode helps to clarify the presence and size of an open oval window, identify turbulent blood flow in the area of the oval foramen, its speed and the approximate volume of the shunt.

In older children, adolescents and adults, a more informative transesophageal echocardiography, supplemented by a test with bubble contrast and a test with straining (Valsalva maneuver), is used to diagnose a patent foramen ovale. Bubble contrast improves the visualization of the open oval window, allows you to determine its exact dimensions, and assess the pathological blood shunt.

The most informative, but more aggressive method for diagnosing an open foramen ovale is cardiac catheterization, which is performed immediately before surgical treatment in a specialized cardiac surgery hospital.

Testing for the presence of a patent foramen ovale should be performed in patients with varicose veins, thrombophlebitis, cerebrovascular accident, chronic lung diseases, which are at risk of developing paradoxical embolism.

Treatment of open oval window

At asymptomatic a patent oval window can be considered a normal variant. Patients with a patent foramen ovale and a history of a transient ischemic attack or stroke are prescribed systemic therapy with anticoagulants and antiplatelet agents (warfarin, acetylsalicylic acid) to prevent thromboembolic complications. The method for monitoring anticoagulant therapy is the international normalized ratio (INR), which should be in the range of 2-3 when the foramen ovale is open.

The need to eliminate a patent foramen ovale is determined by the volume of shunted blood and its effect on the functioning of the cardiovascular system. If there is a small discharge of blood, there are no concomitant pathologies and complications, surgery is not required.

In case of pronounced pathological discharge of blood from the right atrium to the left, low-traumatic X-ray endovascular occlusion of the open foramen ovale is performed. The operation is carried out under X-ray and echocardioscopic control using a special occluder, which, when opened, completely plugs the hole.

Prognosis of open oval window

For patients with a patent foramen ovale, regular monitoring by a cardiologist and echocardiography are recommended. Endovascular occlusion of the patent foramen ovale allows patients to return to their normal rhythm of life without restrictions. In the first 6 months after surgical treatment of an open oval window, antibiotics are recommended to prevent the development of bacterial endocarditis. The greatest effect from endovascular closure of the patent foramen ovale is observed in patients with platypnea who had a pronounced right-to-left shunt.

The news of an open foramen ovale in the heart alarms and worries many parents of children of different ages. As a rule, they learn about this diagnosis completely by accident: during a routine examination or an ECG. In some cases, such an anomaly in the development of the heart does not manifest itself at all, and people live for many years without experiencing any inconvenience until serious ones appear.

In recent years, this feature in the structure of the heart has begun to be detected much more often, and in our article we will tell you about an open foramen ovale in the heart and the dangers that this diagnosis may pose in the future.

What is a patent foramen ovale in the heart?

During the first cry of a newborn, the oval window in the heart closes.

The oval window is an open gap in the wall between the right and left atria, which normally functions in the embryonic period and completely closes after 12 months of life. On the left atrium side, the opening is covered by a small valve, which is fully mature by the time of birth.

During the first cry of the newborn and the moment the lungs open, there is a significant increase in pressure in the left atrium and, under its influence, the valve completely closes the oval window. Subsequently, the valve adheres tightly to the wall of the interatrial septum and the gap between the right and left atria closes.

In most cases, in 40-50% of children, such “accretion” of the valve occurs in the first year of life, less often - by the age of five. If the valve size is insufficient, the gap cannot close completely and the right and left atria are not isolated from each other. In such cases, the child may be diagnosed with a patent foramen ovale in the heart (or MARS syndrome). This condition is classified by cardiologists as a minor anomaly of the heart, and, in the absence of severe symptoms affecting the quality of life, can be perceived as individual feature structure of the heart.

An open foramen ovale in the heart is a through hole between the atria through which blood can be pumped from one atrium into another during contraction of the heart muscle.

In adult patients, this anomaly is detected in approximately 30% of cases. It is a channel, or shunt, between the atria and can cause problems in the functioning of the cardiovascular system or lungs due to changes in blood pressure.

Causes

Most common cause non-closure of the fissure between the atria becomes a genetic predisposition. In most cases, this anomaly is inherited through the maternal line, but can also be caused by a number of other reasons:

prematurity of the child;
connective tissue dysplasia;
congenital heart defects;
drug addiction or mothers;
smoking during pregnancy;
toxic poisoning from certain medications during pregnancy;
stress;
insufficient nutrition of a pregnant woman;
unfavorable environment.

A patent foramen ovale is often detected with other cardiac malformations: with open and congenital defects tricuspid and valves.

Various risk factors can contribute to the opening of the oval window:

excessive physical activity (weightlifting and gymnastics, strength sports, diving);
episodes of pulmonary embolism in patients with pelvic or

Symptoms

More often, an open foramen ovale in the heart does not manifest itself in any way, or makes itself felt only by scanty and nonspecific symptoms.

Young children with this anomaly may experience:

blueness or sharp pallor of the circumlabial area or nasolabial triangle during straining, screaming, crying, coughing or bathing;
tendency to bronchopulmonary diseases;
slow weight gain.

Older children may have poor exercise tolerance, which manifests itself by increased heart rate and.

During puberty or during pregnancy, when a total hormonal change occurs in the body, provoking an increase in the load on the cardiovascular system, a patent foramen ovale can manifest itself in frequent episodes and, rapid fatigue and sensations of interruptions in the functioning of the heart. These manifestations are especially pronounced after intense physical activity. In some cases, such an anomaly in the development of the heart can lead to sudden and unmotivated fainting.

Non-closure of the oval window before the age of five indicates that, most likely, this anomaly will accompany the person throughout his life. IN at a young age and in the absence of cardiovascular lesions, it will have practically no effect on his well-being and work activity, but after 40-50 years and the development of heart or vascular diseases, the oval window can aggravate the course of these ailments and complicate their treatment.

Diagnostics

When auscultating heart sounds, the doctor may suspect patent foramen ovale, since this anomaly is accompanied by systolic murmurs varying intensity. To confirm this diagnosis, the patient is recommended to use more accurate instrumental examination methods:

Echo-CG (conventional and Doppler, transesophageal, contrast);
radiography.

Invasive and more aggressive diagnosis of an open oval window is resorted to if surgery is necessary. In such cases, patients are prescribed probing of the cavities of the heart.

Treatment

If there are no signs of decreased heart function, a child with a patent foramen ovale is cared for as if he were healthy, without the use of medications.

The volume of treatment is determined by the severity of the symptoms of an open oval window. In the absence of pronounced disturbances in the functioning of the heart, the patient is given. Reception medications in the asymptomatic case, such an anomaly of the heart structure is not prescribed, and the patient is recommended to undergo restorative procedures (physical therapy, hardening and sanatorium-resort treatment).

If a patient has minor complaints about the functioning of the cardiovascular system, it may be recommended to take vitamin preparations and products that provide an additional restorative effect on the heart muscle (Panangin, Magne B6, Elcar, Ubiquinone, etc.). In such cases, the patient must adhere to greater restrictions in physical activity and pay attention to general strengthening procedures.

With more pronounced manifestation symptoms, a high risk of thrombus formation and a significant discharge of blood from one of the atria to the other, the patient is recommended to be monitored by a cardiologist and cardiac surgeon and the following measures may be prescribed:

taking antiplatelet agents and anticoagulants (to prevent blood clots);
endovascular treatment (through a catheter, which is inserted into the femoral artery and advanced into the right atrium, a patch is applied to the oval window, it stimulates the opening to close with connective tissue and resolves on its own after a month).

In the postoperative period, the patient is prescribed antibiotics for prophylaxis. Endovascular treatment of such an anomaly in the development of the heart wall allows patients to return to absolutely full life without any restrictions.

Possible complications

Complications of patent oval window develop quite rarely. This anomalous structure heart wall lead to the following diseases:

kidney infarction;
transient cerebrovascular accident.

The cause of their development is paradoxical embolism. Although this complication is quite rare, the patient should always inform their doctor about the presence of a patent foramen ovale.

Forecasts

In the vast majority of cases, the prognosis for patients with a patent foramen ovale is favorable and rarely results in complications.

constant monitoring by a cardiologist and echo-CG control;
refusal of extreme and accompanied by significant physical activity types of sports;
restrictions in the choice of professions associated with significant respiratory and cardiac stress (divers, firefighters, astronauts, pilots, etc.).

Surgical treatment for such an anomaly of heart development is prescribed only in cases of severe disturbances in the functioning of the cardiovascular system and lungs.