What contributes to the closure of the oval window in a child. Patent foramen ovale

Open oval window. The parents of about one child in three hundred hear a similar diagnosis. This diagnosis is made on the basis of an ultrasound examination of the child’s heart. Of course, any mom and dad will be simply dumbfounded when they hear such a diagnosis from a doctor. They have dozens of a wide variety of concerns and questions, for example, why did this happen, can it go away on its own and how soon, what could be the consequences, who is to blame and what to do?

And this concern of parents is absolutely understandable and natural - after all, the health of the child is always in the first place for any father or mother. I would like to immediately reassure parents - there is no need to engage in self-flagellation, because it is simply impossible to foresee the possibility of the development of such an anomaly in advance, even with all the great desire. And secondly, no matter how unpleasant this pathology is, it does not pose a direct threat to the child’s life.

What is a patent foramen ovale?

The doctor should tell the parents in detail about all the nuances of this cardiac anomaly. However, in practice, unfortunately, this does not always happen. For some reason, many doctors mistakenly believe that parents do not need this information. And parents are either in painful ignorance, or are independently trying to find information in various sources, sometimes not entirely correct.

It is for such parents that this article was written. After reading it, you will have enough information that will allow you to have an accurate idea of ​​what exactly is going on with your child and how you can help him.

So, what is a patent foramen ovale? Doctors use these terms to describe a cardiac anomaly in which the communication between the right and left atria that exists in any child during intrauterine development is either fully or partially preserved. The blood supply to a child during intrauterine development occurs with the participation of a wide oval window in the heart.

After the baby is born and takes its first breath, the pressure between the atria changes radically. At proper development In the child, the edges of the wide oval window are fused with the edges of the valve. By about six months of age, the oval window closes completely in about half of all babies. In another 30% of children, closure of the oval window occurs by the end of the first year of life.

In all other cases, closure of the oval window can occur completely spontaneously, and at any time. According to medical statistics and the observations of cardiologists, approximately 15 percent of adults are also diagnosed with an open foramen ovale.

Symptoms of this pathology

As a rule, in the vast majority of cases, the presence of an open oval window in a child does not manifest itself with any symptoms. In most cases, it is discovered completely by accident, during a routine ultrasound examination. However, there are still several nuances by which an experienced pediatrician may suspect that a child may have this cardiac pathology:

• In the event that during physical exertion, as well as coughing or crying, the child develops even slightly pronounced cyanosis. For reference: cyanosis is when the skin of the lips or nasolabial triangle, as well as any mucous membranes, has a bluish tint.
• Frequent illnesses of the child with colds or inflammatory diseases of the organs respiratory system- bronchi or lungs.
• Slowing down the normal pace physical development, especially pronounced.
• The child's inability to perform any physical activity, especially if there is respiratory failure.
• The child systematically loses consciousness or has symptoms of cerebrovascular accident.

If the doctor has any suspicions about an open foramen ovale, he will definitely send the child for an ultrasound examination of the heart and a consultation with a cardiologist.

Two views on one problem

There are two medical points of view on the problem of an open oval window in children. Supporters of one of the versions are firmly convinced that the open oval window is absolutely harmless phenomenon, requiring absolutely no attention from a cardiologist. And even more so, it should not become a cause for concern and panic among parents. Proponents of this point of view believe that with this cardiac anomaly there is no hemodynamic disturbance. And accordingly, surgery for the purpose of correction has no justifiable meaning.

Proponents of a different point of view believe that such a cardiac anomaly eloquently indicates that a child who has an open foramen ovale has a much higher risk of developing conditions that pose a threat to the child’s life, for example, embolism. However, as practice shows, in children with a patent oval window, such a complication does not occur more often than in healthy children.

The only case in which the risk of developing such complications actually increases significantly is if the child is professionally involved in one or another sport. This happens due to the fact that both psycho-emotional and physical activity greatly exceed due to the child according to age standards.

And another case in which the risk of developing complications from a patent foramen ovale may increase is if the child, among other things, has a heart anomaly such as an aneurysm of the interatrial septum. In this case, the likelihood of cardioembolic complications increases by at least 50%.

What to do?

So, the doctor performed all the necessary examinations of the child, on the basis of which an accurate diagnosis was made: “open oval window.” The most important question that parents and the cardiologist need to discuss is what to do next? What measures will the doctor take, and what should the parents’ line of behavior be if this heart pathology is detected in the baby?

As a rule, the doctor chooses the following tactics for managing such a small patient. The child must always be under the strict supervision of a cardiologist. Parents should maintain close contact with a cardiologist, informing him of all, even very minor changes in the child’s condition.

About once a year, the child must undergo a study that will help determine the exact size of the oval window. If the size of the oval window begins to decrease, the doctor will continue to take a wait-and-see policy. Sooner or later, in such cases, the oval window completely closes completely on its own.

In the same case, if for some reason this does not happen for a long time, the doctor may decide on the need for surgical intervention, the purpose of which is to artificially close the window.

I would like to once again urge mothers and fathers whose children have an open foramen ovale to remain calm. Panic is never a good thing!

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When is a patent foramen ovale physiological?

The foramen ovale is the opening between the right and left atria. It is open only during the child’s intrauterine life. Oxygen is supplied to the fetus through the umbilical cord; the lungs do not function and do not require a lot of nourishing blood. Therefore, while the pulmonary circulation is closed, part of the blood is discharged from the right atrium to the left through the oval window. The window is covered with a valve that functions like a door on a spring: it opens only towards the left atrium.

But everything changes with the birth of a child. After the first breath, the lungs of a newborn are cleared of intrauterine fluid, filled with air, and blood enters them through the pulmonary circulation. From now on, the work of the oval window is completed. In the left atrium, pressure increases, which tightly presses the oval window valve to the interatrial septum. This prevents the valve door from opening again and creates conditions for it to become overgrown.

Dimensions and standards

Closure of the oval window normally occurs within a period of 3 months to 2 years. But even at 5 years old such a finding is considered normal.

According to statistics, 50% of healthy children aged 5 and 10–25% of adults have this feature. Separately, it is worth noting that it is not a vice. Doctors call it MARS - minor anomaly of the heart. It distinguishes the structure of the heart from the anatomical norm, but does not pose an immediate threat to health.

In 1930, T. Thompson and W. Evans examined 1,100 hearts, the results were as follows: 35% of those examined had an open foramen ovale, 6% of them had a 7 mm diameter (half of them were children under 6 months). In adults, large-diameter PFOs occurred in 3% of cases.

Window sizes can be different: from 3 mm to 19 mm (usually up to 4.5 mm). First of all, they depend on the patient’s age and the size of his heart. The indication for surgical treatment does not depend on the size of the window, but on how much it is covered by the valve and the degree of compensation.

When does a patent foramen ovale become a pathology?

The presence of an oval window in itself is not a problem. After all, it does not cause circulatory disorders, but functions only when severe cough, heavy physical activity.

Problems arise in the following cases:

• when a child's heart enlarges with age, but the valve does not grow. Then the oval window does not close as tightly as it should. As a result, blood can leak from the atrium into the atrium, increasing the load on them.
• the appearance of diseases or conditions that increase the pressure in the right atrium, therefore leading to the opening of the valve door towards the left atrium. This chronic diseases lungs, diseases of the veins of the lower extremities, combined pathology of the heart, as well as pregnancy and childbirth.

In these cases, constant monitoring and supervision by a doctor is necessary so as not to miss the moment of transition from a compensated state to a decompensated one.

Interestingly, sometimes this feature can alleviate a person’s condition and even prolong his life. We are talking about the primary pulmonary hypertension when the blood in the pulmonary vessels is under pressure. This is manifested by shortness of breath, chronic cough, weakness, fainting. Thanks to the open foramen ovale, part of the blood from the pulmonary circulation is discharged into the left atrium, unloading the blood vessels of the lungs and reducing symptoms.

Reasons for non-closure of the oval window of the heart

There is more than one theory and assumption on this matter. But there are no reliable ones yet. In the event that the valve does not fuse with the circumference of the oval window, they speak of a peculiarity of the organism. This confirms the number of incidental findings during echocardiography.

It happens that the valve is initially small and is not able to completely close the window. The cause of such underdevelopment can be any factor affecting the formation of fetal organs:

• maternal smoking and drinking
• working with harmful and toxic substances
• ecology, stress.

Therefore, an open foramen ovale in children is often combined with prematurity, immaturity and other pathologies of intrauterine development.

Signs

As already mentioned, there is no clinical picture for this pathology, and the anomaly itself is detected randomly. There are usually no complications or consequences.

Combination of an open oval window with other diseases. Symptoms appear when hemodynamics (proper blood flow through the chambers of the heart) are impaired. This happens when there are combined heart defects, for example:

• patent ductus arteriosus;
• defects of the mitral or tricuspid valves.

The chambers of the heart are overloaded, the interatrial septum is stretched, and the valve cannot perform its functions. Right-left shunting appears.

Symptoms in children

• This may manifest itself frequent illnesses lungs and bronchi.
• During periods of stress (crying, coughing, physical activity, attacks of bronchial asthma), the area of ​​the nasolabial triangle becomes cyanotic and the lips turn blue.
• The child is somewhat behind in physical development and growth. Physical exercise causes fatigue and shortness of breath inadequate to the load.
• Spontaneous, unexplained fainting appears. This is especially true for young people with diseases of the veins of the lower extremities.

Symptoms in adults

• With age, examination reveals signs of pulmonary hypertension and overload of the right side of the heart.
• This, in turn, leads to changes in the ECG: conduction disturbances along the right bundle branch, signs of enlargement of the right chambers of the heart.
• An open foramen ovale in an adult, according to statistics, increases the incidence of migraines.
• Data on the possible development of a stroke or heart attack have appeared a long time ago. The case when a blood clot, a piece of tumor or foreign body penetrate from the venous system into the arterial system and clog the vessel there, called paradoxical embolism. Once it enters the vessels of the heart, it causes myocardial infarction. Into the vessels of the kidney - kidney infarction. In the vessels of the brain - ischemic stroke or transient ischemic attack.
• Also in adults, a paradoxical syndrome such as platypnea-orthodeoxia may appear. A person experiences shortness of breath when getting out of bed, and disappears when he returns to a lying position.

How to determine a patent oval window?

Inspection

Typically, an external examination of the patient does not provide any information about congenital anomaly. An oval open window in a child’s heart can sometimes be suspected in the maternity hospital when diffuse cyanosis of the entire body appears skin. But this symptom must be differentiated from other pathologies.

EchoCG

Most often, an open window between the atria is found during an ultrasound of the heart. It is better to perform echocardiography with Doppler. But with small window sizes, these techniques will not be able to detect an anomaly.

Therefore, the “gold standard” for detecting PFO is transesophageal echocardiography. It allows you to see the window itself, closing its sash, assess the volume of shunted blood, and also carry out a differential diagnosis with an atrial septal defect - a real heart defect.

As an invasive method, angiocardiography is also very informative. The last two methods are used only in specialized cardiology clinics.

Divers and the patent foramen ovale

In the presence of such a heart anomaly, engaging in certain types of work becomes life-threatening. In particular, the profession of a diver is dangerous because when quickly descending to depth, gases dissolved in the blood turn into bubbles. They can penetrate the right-left oval window shunt into the artery and cause embolism, which can lead to death.

By similar reason Persons with an open oval window are not allowed to engage in professional activities associated with overload. These are pilots, astronauts, machinists, dispatchers, drivers, operators, scuba divers, submarine crews, and caisson workers. Recreational diving is also dangerous.

The army and the oval window

The presence of a patent foramen ovale limits conscription into the army. As already mentioned, loads increase the right-left shunt, and with it the likelihood of an accident due to embolism.

During service, the soldier will have to perform forced marches, shooting, and drill training. The military medical examination considers such conscripts to be a “risk group” and considers it advisable to conduct an in-depth examination of such young people. After confirmation of the diagnosis, the conscript is assigned to category “B” with a limitation of suitability for military service.

Treatment

Currently, treatment tactics are based on the presence or absence of symptoms.

Treatment of LLC in the absence of symptoms

No therapy required. Observation by a pediatrician, therapist and cardiologist with an assessment of the dynamics of the condition of the oval window using ultrasound is sufficient.

Persons without severe symptoms, but at risk of developing ischemic attack, stroke, heart attack, with venous disease of the lower extremities, it is recommended to take courses of blood thinning medications (aspirin, warfarin, clopidogrel).

Treatment of LLC in the presence of symptoms

Surgical treatment is aimed at closing the defect with an occluding device. It is used for severe right-to-left shunting, with a high risk of paradoxical embolism, and also as a prophylaxis for open foramen ovale in divers.

The occlusion device is attached to the catheter and inserted into the heart cavity through the femoral vein. The operation is performed under visual X-ray control. After the catheter inserts the occluder into the oval window, it opens like an umbrella and tightly closes the hole. The method allows to improve the quality of life of such patients.

As an alternative to occluders, scientists at the Royal Bronton Hospital in London proposed using a special absorbable patch. It is attached to the oval window, and the patch stimulates the natural healing of tissue deficiency within a month. The patch then dissolves. This method avoids this side effect, as inflammation of the tissue around the occluder.

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What is a patent foramen ovale in the heart?

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

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

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

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, occasional circulatory problems may occur. 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.

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.

We bring to your attention an article about cardiac chord in a child.

Symptoms, signs of deviation from the norm

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:

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

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

In such cases, constant medical supervision is necessary.

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

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 establish an accurate diagnosis.

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

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

Treatment of an open oval window in the heart

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

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

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

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

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

• 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 arteries of the pelvis, elbow joint or neck are used after a puncture is performed in them.

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

This method allows for surgical intervention without the use of widely used techniques:

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

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

Complications, consequences

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

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

• Even in the absence of pronounced symptoms It is necessary to register the child with a cardiologist. The doctor should monitor the child regularly.
• Patent foramen ovale in the heart and sports accompanied by heavy loads are incompatible. Exercise should not contain strength exercises and excessive tension of the abdominal muscles. The child should be protected from running, squats, jumping and anything that could provoke a shunt.
• You should organize your daily routine correctly to balance the child’s periods of activity and rest. Must be included in schedule nap.
• 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 prevention in the future of a stroke - lead an active lifestyle to prevent blood stagnation in lower limbs and prevent vein diseases.
• Experts recommend hardening and restorative procedures.
• Children with this diagnosis an annual holiday at the resort and regular walks on the fresh air.
• 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.

Always be calm, good-natured and attentive to your child. Take care of his mental comfort. And over time, transformations in the oval window of his heart will lead to its overgrowth. The main thing is to follow the recommendations of specialists.

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When should the foramen ovale in a child’s heart close?

A patent foramen ovale must gradually close as it interferes with normal blood circulation through the pulmonary system. Closing of the oval window occurs gradually by the valve growing to the edges of the oval fossa and may lasts individually for each child– for some immediately, for others in a year, two, or five. This is normal and, in the absence of other heart diseases, should not cause concern to parents. In 20-30% of cases, the opening between the atria is not tightly closed, and the oval window can remain open throughout life.

In rare cases, the oval foramen remains completely open - this defect is more clearly visible on ultrasound and is called atrial septal defect(ASD). The difference between a foramen ovale and an atrial septal defect is that the oval window has a working valve, while an atrial septal defect does not.

An open foramen ovale in a child’s heart is not a defect, but belongs to minor anomalies of cardiac development (MADC); such children from the age of three belong to the second health group. For conscripts, an open foramen ovale without bleeding provides fitness category “B”, that is, fit for military service with minor restrictions.

How to recognize a patent foramen ovale?

In most cases, the presence of an open oval window is discovered by chance, during examination as part of a medical examination or when the presence is suspected. small defect with the following symptoms:

• in newborns and infants - blueness around the mouth (cyanosis of the lips or nasolabial triangle) when coughing, screaming, crying, or during bowel movements. At rest the blueness disappears;
• in older children - low endurance to physical activity, rapid fatigue, unexplained episodes of dizziness and loss of consciousness;
• predisposition to frequent colds and inflammatory diseases of the respiratory system.
• a murmur is heard in the child's heart.

If a child is suspected of having an open foramen ovale, the pediatrician refers him to a consultation with a cardiologist and echocardiography (ultrasound of the heart, EchoCG). An ultrasound of the heart will allow you to see and recognize the hole in the interpreserial septum, as well as the opening valve of the patent foramen ovale. In addition, ultrasound can determine how much blood passes through the defect in the interatrial septum, in which direction the blood moves through the heart, and what other abnormalities there are in it.

An open oval window according to ultrasound is characterized by the following signs: small size (from 2 to 5 mm, on average 4.5 mm), visualization of the valve in the cavity of the left atrium, location in the middle part of the interatrial septum (in the area of ​​the fossa ovale), inconsistent visualization, thinning of the walls of the interatrial septum in the area of ​​the oval window (with a septal defect, the edges are thickened).

Treatment of open oval window

Most often, the presence of a patent foramen ovale does not cause any complaints, complications occur extremely rarely, and no treatment is required. Several specific loads pose a risk of complications for children and adults with a patent foramen ovale. In older children, blood discharge may occur during paroxysmal coughing, diving, or exercises accompanied by straining and holding their breath. Therefore, scuba diving, deep-sea diving, and weightlifting are contraindicated for such children.

At older ages, under conditions that increase right atrial pressure, the opening of the oval window is possible, in particular during pregnancy, severe pulmonary insufficiency and pulmonary embolism (blockage of the pulmonary artery with blood clots).

If in a child or adult, apart from the open oval window, no other disturbances in the functioning of the heart are found, if he does not suffer from chronic diseases of the veins and lungs, and this hole does not greatly interfere with blood circulation, then there is no reason to worry. In this case, doctors advise only to avoid unnecessary physical activity and to be observed by a cardiologist, periodically repeating an ultrasound of the heart (monitor the size of the hole).

If there is a high risk of thrombosis (blood clots), medications that prevent the formation of blood clots (anticoagulants) are prescribed.

However, if the hole reaches a significant size, blood is discharged from one atrium to another - surgical intervention may be required. To do this, a catheter (tube) is inserted into the artery, at the tip of which there is a special device, which, when inserted into the oval window, completely clogs it.

The patent foramen ovale in the heart is a small hole located in the septum directly between the right and left atria. Normally, they should not communicate with each other so that there is no mixing of arterial and venous blood, as well as pressure drops. This condition is a pathological phenomenon in adults and children of a certain age and is very common. Sometimes the disease does not cause serious physical discomfort, but in some cases it can lead to various disorders in the functioning of the cardiovascular system and requires treatment.

The presence of an oval-shaped depression is normal, because during pregnancy, while the fetus’s lungs are not functioning and its body requires additional oxygen, blood is transferred to the left atrium through this hole. The absence of such a duct during intrauterine development can lead to various anomalies and even the death of the child before birth or immediately after it.

When the baby takes his first breath, the respiratory system starts working and his lungs immediately expand. The increased pressure in the left side of the heart stops the flow of blood through the foramen ovale.

In a newborn baby, the foramen ovale in the heart should close within a few days or weeks. But very often, during the next scheduled medical examination, it is discovered that this did not happen, and the doctor informs the parents about pathological abnormalities in the development of the infant’s cardiovascular system. An unclosed oval window in most cases requires some treatment, but the famous children's pediatrician E.O. Komarovsky advises parents not to panic and not resort to radical measures. In his works, he emphasizes the fact that in almost half of all newborns there is no sudden closure of the hole in the heart septum and it can remain open for a long time, up to the age of five.

Despite the fact that an unclosed passage in the septum between the two atria can be considered a normal variant for some time, there are other factors in the occurrence of a physical defect. They can cause the development of various pathological changes in the functioning of the heart muscle. These factors include:

• smoking and drinking alcohol during pregnancy;
• various malformations of intrauterine development (including infection);
• taking medications inconsistently with a doctor;
• hereditary factor.

If the child was born prematurely, this also increases the risk that the hole in the heart will not close, and blood will be transferred through it with a weak pulsation. With various anomalies in the structure and development of the heart muscle, a sharp opening of the previously connected oval window may occur due to temporary stretching of the chambers of the left and right atria.

Symptoms

In some cases, the hole does not heal even after several years of life. If a teenager has an unclosed window, then this defect will definitely remain with him forever. Why is this dangerous? In fact, according to official statistics, this phenomenon accompanies at least 25% of the entire adult working population throughout their lives. At the same time, restrictions are imposed only on extreme sports and activities associated with constant physical activity. Caution is necessary because the presence of an open foramen ovale in the heart in an adult can lead to sudden changes in blood pressure.

Much less common are cases with a pronounced clinical picture of the disease, when the following pathological conditions make themselves felt:

• diseases of the respiratory system;
• cerebral circulatory disorders and tendency to thrombosis;
• varicose veins;
• severe headaches of a chronic nature;

• exceeding the normal level of blood volume in the lungs;
• exercise intolerance;
• arrhythmia and shortness of breath;
• numbness of the limbs;
• mobility impairment different parts bodies;
• pathological changes in the right atrium (usually clearly visible during ultrasound);
• systematic fainting of unknown etiology.

In most cases, the disease is hidden and difficult to diagnose, so it is detected through random medical examinations and checks. Absence specific signs also complicates the search for the main cause of ailments in adults, because the above symptoms occur in various pathologies.

Possible complications

An open window in the heart rarely poses a serious threat to human health and has virtually no effect on life expectancy, but worsens its quality. But this pathology, in combination with other chronic respiratory diseases, varicose veins and thrombophlebitis, can lead to serious complications, which include:

• myocardial infarction;
• kidney infarction;
• stroke.

In addition, a temporary disruption of the blood supply to the brain may occur, which can lead to memory loss, central nervous system depression, body immobility, numbness of the limbs and speech defects. After some time, these symptoms may disappear without a trace.

Treatment of the disease

If, during a medical examination, an open depression in the heart was revealed, but it does not bring any physical discomfort to the person, then special treatment is not carried out. For minor complications, various drugs are prescribed to prevent the formation of deep vein thrombosis.

In some cases, the defect can be corrected through surgery.

Doctors often use special absorbable patches, which are temporary patches for the oval window.

During the period of their use, connective tissue grows, which subsequently closes the duct between the atria.

Forecast

This disease generally has a good prognosis, but in order to avoid various complications, periodic ultrasound examinations (especially for newborn children) and visits to a cardiologist are required. You should also avoid physical fatigue and increased stress.

The same rules apply for teenagers. Parents should not send their children to boxing or martial arts classes, and it is better to avoid school competitions if possible, providing a certificate in advance about the presence of a birth defect.

If you exclude all kinds of risks and treat concomitant diseases in a timely manner, you can live almost your entire life without remembering this problem. Pathology is not an obstacle to pregnancy and natural childbirth, but a woman must notify her obstetrician-gynecologist. In old age, the disease sometimes causes heart failure, so from time to time you need to undergo routine examinations and carry out prevention with medications or traditional medicine.

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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), you need special structure hearts.

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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, “adult” type. This occurs due to the expansion of the lungs, breathing, the first cry and the activation of the pulmonary vein system and pulmonary arteries. You remember that in the lungs everything is the other way around - blood comes from the lungs through the veins, and it is arterial, and the pulmonary artery collects venous blood from the whole body and enriches it with oxygen in the lungs. Due to changes in pressure in the left atrium oval window It is closed with a special valve like a door and the edges of the valve are attached to the hole tightly.

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 times– from two months to a year. Sometimes this happens longer, up to two to five years. This is quite normal. 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. The causes of this phenomenon are considered to be 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 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?
Given the small size of the defects, this is a completely normal child and this condition is not considered to be any defect, so he will not have any manifestations. OOO is detected during routine ultrasound examinations, which are required for 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 the rate of mental or physical development compared to peers.
- listening to a heart murmur
- systematic attacks of loss of consciousness, manifestation of symptoms of cerebrovascular accident
- 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 should I do?
When a diagnosis of “patent foramen ovale” is made, it is necessary to decide on the further actions of the 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, and when blood pressure in the right side of the heart increases. In older children, this can happen with a strong cough, exercises with straining and holding your breath, or 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 he has a normal lifestyle 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.

– 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 (with hacking cough, 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 patent foramen ovale can be caused by hereditary predisposition, prematurity, congenital heart defects, connective tissue dysplasia, exposure to adverse environmental factors, smoking and alcohol consumption by women 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 oval fossa on the inner left wall of the right atrium, often has no large size(with a pin head) and slit-shaped. 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 a 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 usual image life.

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, renal 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 inflammation 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 a decrease in arterial blood oxygen saturation in a standing position with an improvement in the condition upon transition to horizontal position. Complications of a patent oval window occur rarely. For paradoxical embolism cerebral vessels, aggravating this anomaly, is characterized by a 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 foramen ovale, radiological signs of enlargement of the right chambers of the heart and an increase in blood volume in the vascular bed of the lungs may be detected.

In newborns and children early age 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 is necessary for 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. Greatest effect from endovascular closure of the patent foramen ovale is observed in patients with platypnea who had a pronounced right-to-left shunt.

Recently, more and more often, after a regular visit to the doctor, mothers are informed that their child has a patent foramen ovale. These words may cause shock and cause for concern. But few people know that this window is necessary for the fetus to have normal blood circulation and provide it with oxygen in the womb.

With the normal development of the baby after birth, this hole closes or this may happen a little later. But there are cases when this does not happen, and then doctors give certain recommendations on nutrition, lifestyle and treatment.

Any abnormal changes in your child should be monitored. Modern young mothers need to remember that your baby is directly related to you. Therefore, everything you consume during pregnancy is passed on to the fetus. So what is an oval window in the heart in children, why is it necessary, what are the reasons for its not closing, as well as treatment methods. You will learn all this information in this article.

Foramen ovale in the heart in children - general information

Foramen ovale in the heart in children

A physiological feature appears in the embryo during intrauterine development. The two atria are connected by an opening through which blood passes. The fetal lungs are compressed and do not function; they do not require oxygenation through the blood.

This arrangement of the heart accelerates the blood circulation cycle and saturation of the organs that need it (primarily the brain and spinal cord). When a child is born, takes his first breath, his lungs open and begin to function fully.

There comes a need for sufficient blood supply to them. The hole in the heart becomes unnecessary. It begins to close after the first breath due to increased pressure in the left atrium.

Nature provides a valve that slams shut and blocks the flow of blood. Ideally, the window closes within the first five hours of life and disappears completely by the age of 1 year. An open window in the heart in a two-year-old child is also considered normal.

Having closed with a valve, it is gradually overgrown with connecting and muscle tissue. In some cases, when examining a child, doctors discover an unclosed hole. If this occurs over the age of 2 years, then a minor anomaly of cardiac development is diagnosed.