What is an oval window in the heart. Oval window in the heart in adults: its formation and danger. What professions are contraindicated with an open oval window

According to statistics, the prevalence of an open oval window (OOO) in the heart differs in different age categories... For example, in children under one year old, this is considered a variant of the norm, since according to ultrasound data, the foramen ovale is found in 40% of infants. In adults, this anomaly occurs in 3.65% of the population. However, people with multiple heart defects have a gaping oval window is registered in 8.9% of cases.

What is the "oval window" in the heart?

The oval window is a flapped orifice located in the septum between the right and left atria. The most important difference between this anomaly and a defect in atrial septum(ASD) consists in the fact that the oval window is equipped with a valve and is localized directly in the oval fossa region, while in ASD it is the part of the septum that is absent.

Fetal blood circulation and the role of the oval window

Fetal circulation is different from that of an adult. During the prenatal period, the baby has the so-called "fetal" (fruit) structures in the cardiovascular system. These include the oval window, aortic and venous ducts. All these structures are necessary for one simple reason: the fetus does not breathe air during pregnancy, which means that its lungs do not participate in the process of saturating the blood with oxygen.

But first things first:

So, oxygen-enriched blood enters the fetus through the umbilical veins, one of which flows into the liver, and the other into the inferior vena cava through the so-called venous duct. Simply put, pure arterial blood only reaches the fetal liver, because in the prenatal period it performs an important hematopoietic function (for this reason, the liver occupies most abdominal cavity the baby).
Then two streams of mixed blood from the upper and lower parts of the body flow into the right atrium, where, thanks to the functioning oval window, most of the blood flows into the left atrium.

The remaining blood flows into the pulmonary artery. But the question arises: why? After all, we already know that the pulmonary circulation in the fetus does not perform the function of oxygenation (oxygenation) of the blood. It is for this reason that there is a third fetal communication between the pulmonary trunk and the aortic arch - this is the aortic duct. Through it, the remaining blood is discharged from the small circle to the large one.

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

During the first year of life, as a rule, the valve grows completely on its own with the walls of the opening. However, this does not mean at all that an unclosed oval opening after 1 year of a child's life is considered a pathology. It has been established that the communication between the atria can also close later. Often, cases are recorded when this process is completed only by the age of 5 years of age.

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 reason for this pathology is a genetic factor. It has been proven that non-closure of the valve flap persists in people with a predisposition to connective tissue dysplasia, which is inherited. It is for this reason that in this category of patients, you can find other signs of a decrease in the 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 affect the non-closure of the oval window:

Unfavorable ecology;
Taking certain medications during pregnancy. Most often, this pathology is caused by non-steroidal anti-inflammatory drugs (NSAIDs). It has been proven that these drugs cause a decrease in the level of prostaglandins in the blood, which are responsible for the closure of the oval window. At the same time, taking NSAIDs is dangerous in late dates gestation, which is the reason why the oval window did not close;
Drinking alcohol, as well as smoking during pregnancy;
Premature birth (this pathology is more often diagnosed in premature babies).

Types of oval window by degree of non-closure

If the size of the hole does not exceed 5-7 mm, then usually in such a situation, the detection of the oval window is a finding in echocardiography. Traditionally, it is believed that a flap valve protects against backflow of blood. That is why this option is hemodynamically insignificant and manifests itself only with 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 is clinical signs may practically not differ from ASD. Therefore, in these situations, the border is very arbitrary. However, from an anatomical point of view, there is no valve in ASD.

How does the disease manifest itself?

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

For kids infancy when the oval window is open, it is characteristic:

Blue lips, nose tip, fingers when crying, straining, coughing (cyanosis);

Pallor of the skin;
Rapid heartbeat in infants.

In adults with pathology, blueness of the lips may also appear when:

Physical activity, which is fraught with an increase in pressure in the pulmonary vessels ( long delay breathing, swimming, diving);
Heavy physical labor (weightlifting, acrobatic gymnastics);
With lung diseases (bronchial asthma, cystic fibrosis, pulmonary emphysema, lung atelectasis, pneumonia, with a 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 cyanosis of the skin even with moderate physical exertion;
Weakness;
Dizziness;
Child's lag in physical development.

Diagnostic methods

Echocardiography is the gold standard and the most informative method diagnostics of this pathology. The following symptoms are usually detected:

In contrast to the ASD, when the oval window is open, it is not the absence of a part of the septum that is revealed, but only its wedge-shaped thinning is visible.
Thanks to color Doppler ultrasound, you can see the "turbulence" of the blood flow in the area of the oval window, as well as a slight discharge of blood from the right atrium to the left.
With the small size of the foramen ovale, there are no signs of an increase in the atrial wall, as is typical for ASD.

The most informative is ultrasound procedure heart, conducted not through the chest, but the so-called transesophageal echocardiography. In this study, an ultrasound probe is inserted into the esophagus, as a result of which all structures of the heart are much better visible. This is due to the anatomical proximity of the esophagus and heart muscle. The application of this method is especially important in obesity of the patient, when the visualization of anatomical structures is difficult.

In addition to ultrasound of the heart, other diagnostic methods can be used:

An electrocardiogram may show signs of bundle branch blockade, as well as conduction disturbances in the atria.
With a large oval hole, changes in the radiograph of organs are possible chest(slight increase in atria).

Why is pathology dangerous?

People at risk should avoid severe physical activity, as well as the choice of professions such as scuba diver, diver, diver. It has been proven that in the presence of this pathology, the likelihood of development decompression sickness 5 times than among the healthy population.
In addition, in this category of persons, the development of such a phenomenon as paradoxical embolism is possible. This phenomenon is possible in people with a tendency to thrombus formation in the vessels. lower limbs... A blood clot that has come off the wall of the vessel can get into big circle blood circulation. As a result, a blockage of blood vessels in the brain, heart, kidneys and other organs is possible. If the size of the blood clot is large, it can cause death.
It is important to remember that people with an open oval window 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.

Treatment and prevention of complications

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

Given the likelihood of thromboembolism, patients at risk should also examine the veins of the lower extremities (with an assessment of the patency of the veins, the presence or absence of blood clots in the lumen of the vessels).
When carrying out any surgical interventions in patients with an open oval window, it is necessary to prevent thromboembolism, namely: elastic bandaging of the lower extremities (wearing compression hosiery), as well as taking anticoagulants a few hours before the operation. (You need to know about the presence of a defect and warn the attending physician).
It is important to observe the regime of work and rest, as well as to dose physical activity.
Spa treatment (electrophoresis with magnesium sulfate has a positive effect).

In the presence of blood clots in the lower extremities, these patients need constant monitoring of the blood coagulation system (such indicators as the 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 in patients with an open oval window, there are signs of impaired cardiac conduction according to ECG data, as well as unstable blood pressure... In such situations, you can take drugs that improve metabolic processes in the tissue of the heart muscles:

Medicines containing magnesium (Magne-B6, Magnerot);
Drugs that improve the conduction of nerve impulses (Panangin, Carnitine, B vitamins);
Preparations that activate bioenergetic processes in the heart ("Coenzyme").

Surgery

Surgical intervention may be required with a large diameter of the oval window with blood flow to the left atrium.

At the moment, endovascular surgery has become widespread.

The essence of the intervention is that a thin catheter is inserted through the femoral vein, which is passed through the vasculature to the right atrium. Control over the movement of the catheter is carried out using an X-ray machine, as well as an ultrasound sensor installed through the esophagus. When the region of the oval window is reached, the so-called occluders (or grafts) are passed through the catheter, which are a "patch" that covers the gaping opening. The only drawback of this method is that occluders can cause a local inflammatory reaction in the heart tissue.

In this regard, in recent times use a BioStar absorbable patch. It is passed through a catheter and opens like an "umbrella" in the atrial cavity. A feature of the patch is the ability to induce tissue regeneration. After attaching this patch in 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 highly effective and has already become widespread.

Disease prognosis

With an oval window of less than 5 mm, the prognosis is generally favorable. However, as mentioned above, large diameter the foramen ovale is subject to surgical correction.

Pregnancy and childbirth in women with a defect

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

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

All these factors contribute to the fact that the heart begins to beat faster, and also increases the pressure in the pulmonary artery. In this regard, women with this anomaly in the heart may have adverse complications. Therefore, pregnant women with this pathology are subject to the supervision of a cardiologist.

Are young men with an open oval window being recruited into the army?

Despite the fact that in most cases this heart anomaly occurs without any clinical symptoms, young people with an open oval window are classified in category B with limited fitness for military service. This is due primarily to the fact that with high physical exertion, the likelihood of complications is high.

conclusions

Due to development complementary methods studies revealing such an anomaly as an open oval window has increased significantly.

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

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

Characteristics and symptoms of an open oval window in the heart of a child

The disease with the beautiful name "open oval window" in newborns and children under the age of 5 has recently become widespread. This "window" is an oval opening, up to 3 mm in diameter, located in the median zone of the septal space between the two atria. The septum divides the two atria in half, representing a natural defense, in its center there is a small indentation in the form of an oval fossa. Such a "window" is on the bottom of the recess, supplemented with a valve and can normally close after a certain period. But this does not always happen, therefore, we will consider the open oval window and the method of its treatment in more detail.

In what cases is this the norm

An open oval window in a child's heart is normal. physiological sign then, when independently tightened for 2-5 years. This window is required by the fetus, since through it the atria are able to work and connect with each other. With the help of deepening, the blood from the vena cava instantly passes into the systemic circulation, since the fetal lungs do not yet work at full strength during pregnancy. All children are born with this pathology, and it is always present in babies.

Sometimes the recess closes on its own in a child who has not yet had time to be born, which provokes right ventricular failure and sudden death fetus in the womb or after birth. After birth, the baby breathes fully, the circulation of the lungs begins to work. Since oxygen enters from the lungs into the atria, they no longer need to connect through the opening, and the window closes after a certain period of time.

Important! Since babies are under great stress, and, taking into account their unprepared body, the oval groove still works: during feeding, if the baby is crying or screaming, the pressure in the right heart zone becomes higher.

When ejected venous blood through the indentation in the baby, the triangular zone under the nose turns blue, this symptom guarantees a functioning oval window. It should completely close by the age of five, the duration of the process depends on the characteristics of the organism and manifests itself differently for each child. Usually, the oval does not close immediately; ideally, the valve grows gradually to the edges of the groove. In certain cases, it closes after a short period of time; in others, the duration of the process can be several years.

Symptoms of pathology

The oval window in a newborn is considered the norm and most often does not become a cause for concern. But in about 20-30% of people, such an opening in the atrial zone does not completely grow together and is able to remain in a half-open form throughout life. In rare cases, it remains open: the deviation is recognized by ultrasound of the heart and is a defect of the septum between the atria (ASD). What is the danger of the defect, will the child have health problems in the future?

Important! A person with an open oval window needs to consult a cardiologist more often, he will be able to quickly identify all deviations and prescribe a treatment that prevents complications from occurring.

With baffle problems, the service valve typical of an open oval window is completely missing. But the presence of a hole is not considered a dangerous deviation, it is classified as a small type anomaly (MARS). If it has not closed in a child under three years old, he is considered to be in the second health group. Young people of draft age with this defect are suitable for military service, but with additional restrictions. Such a deepening does not cause problems in life, since it can function when coughing or during physical exertion. Difficulties arise:

when blood passes through the atria, if the oval window in the heart in adults is not completely closed;
in the presence of diseases of the lungs or veins in the legs;
with mixed heart disease;
during the period of gestation and during childbirth.

The main factors

The reasons for the presence of an open oval window of 2 mm or larger in the heart are different, they are influenced physiological features organism of each individual. On this moment no proven scientific theories or assumptions that could fully substantiate and confirm the specific causes of the pathology. When the valve does not fuse with the edges of the oval window, the cause becomes various factors... A removed echocardiography or ultrasound of the heart can reveal the presence of LLC.

Sometimes the valve is not able to close the recess completely due to its too small size, which provokes non-closure of the natural oval window. Underdevelopment of the valve provokes poor ecology and stressful conditions, smoking or drinking alcoholic beverages by the mother during pregnancy, or constant contact with toxic components. An open oval window in the heart of an adult remains if developmental abnormalities, stunted growth or prematurity are found in childhood.

Important! In the presence of thrombophlebitis of the legs or the pelvic area, some people increase the pressure in the area of the right heart regions, which later becomes the reason for the appearance of an open small oval window in adults.

Hereditary causes, dysplasia lesions of connective tissues, defects of the heart or valves of a congenital nature can lead to the opening of windows in older children during development. If a child plays sports, he or she is at risk of developing this defect, since sports can seriously affect health. Since the physical loads in gymnastics, athletics or other sports activities are serious, this provokes the appearance of a window.

Signs depending on age

Standard signs in newborns or adolescents are not recorded when an open oval window appears in the interatrial septum, and often they learn about the presence of a defect by chance, for example: during echocardiography and others diagnostic procedures... Pathology does not threaten with serious complications, with the exception of other complex diseases that can affect it. For example: if a baby or an adult has hemodynamic problems upon detection of heart defects, including a mitral or tricuspid valve or a ductus arteriosus.

Symptoms of such a defect as an open oval window appear in both the infant and adolescents, in specific cases they vary depending on age. When it comes to a baby 4-7 years old, the diagnosis in most cases is made during a standard examination by a pediatrician or pediatric cardiologist... Only ultrasound or echocardiography can confirm the presence of a window. You can find out about the presence of a defect in infants by the main symptom - the blue discoloration of the nasolabial triangular region and the lip area during stress. Other deviations include:

frequent diseases of the lungs and bronchi;
noticeable lag in growth and development;
shortness of breath and excessive fatigue during exercise;
persistent and unreasonable fainting and dizziness;
heart murmurs when listening to a cardiologist.

In some adults, pathologists are accompanied by characteristic symptoms and is temporary and permanent. Sometimes the functional window opens after overgrowth in the presence of special pathologies if the pressure in the right atrial area gradually increases. An open oval window appears in a pregnant woman, with pulmonary insufficiency in a complex shape or when a pulmonary artery is blocked. Despite practically complete absence difficulties, deviation can become a problem and provoke:

hypertension of the lungs and congestion of the right region of the heart;
difficulties with conduction in the area of the right bundle branch;
migraine;
the gradual development of a heart attack or stroke condition;
short-term shortness of breath.

Diagnostic methods

Before you assign complex therapy and to confirm the pathology, the specialist usually prescribes a diagnosis, as a result of which you can accurately find out about the presence of an oval hole. The standard technique is the method of listening, or auscultation, of the sternum during examination of the baby: in pathology, the doctor records systolic-type murmurs. There are more reliable methods including ECG and ultrasound.

If parts of the canal do not completely cover the edges of the hole, it is recommended to contact a specialist as soon as possible and go through full examination... Echocardiography imaging represents main technique, it is assigned to every child who has achieved months of age, as evidenced by the new standards in the field of pediatrics. If a patient has heart defects, he is sometimes recommended to undergo ecocardiography through the esophagus and undergo an angiographic study in a specialized hospital.

Therapeutic measures

The method of treating a child or an adult depends on age, the presence of additional pathologies and on whether the patient has signs of pathology or not. If there are no symptoms, and the defect is not accompanied by additional problems, the patient does not feel worse, you just need to be examined by a pediatrician, therapist and cardiologist. Doctors will be able to assess the state of the oval groove and take appropriate measures in time, prescribe treatment. If the window does not close in a natural way up to five years, then corrective drugs are prescribed.

Important! When it comes to an oval-type window, the dimensions of which do not exceed the normal 5 mm, surgical correction is not required. In the presence of a large deepening, specialists can prescribe an operation in conjunction with corrective therapy.

The risk group includes patients who do not have pronounced signs, but the occurrence of ischemia, heart attack, stroke, pathologies of veins in the legs or other diseases is likely. In some cases, surgery may be required when the oval window is too large in diameter, and blood enters the left atrium. Among the techniques, surgery of the endovascular type stands out: during the operation, the patient is inserted a catheter into the vein of the thigh, which is then carried out to the zone of the right atrium.

The path of the catheter is monitored using an X-ray machine and an ultrasound probe, which are inserted through the esophagus. Then, through such catheters, occluders are passed, which cover the opening well. This technique also has disadvantages, since occluders can provoke inflammatory processes in the tissues of the heart. There is additional way solutions to the problem, which is a special patch inserted through a catheter, which is then opened in the atrium. It regenerates tissue well and dissolves on its own within thirty days.

Preventing complications

The emergence of complications can cause dangerous conditions, including the risk of thromboembolism, such patients need to more often study the condition of the veins in the lower extremities. Adults with an open oval groove usually undergo thromboembolism prophylaxis if surgery is to be done. Such measures include taking anticoagulants or bandaging the legs, a number of additional techniques. Often, with this problem, symptoms of cardiac conduction problems and blood pressure abnormalities can be observed.

Special preparations for improving metabolic processes strengthen the tissues and muscles of the organ during treatment. The list of drugs includes medicines with the addition of magnesium, drugs that can improve the conduction of the heart impulse, drugs that can activate bioenergetic processes. General instructions for patients with an open oval window, include reducing physical activity, adhering to a daily routine, and treatment in sanatoriums.

Open oval window in a newborn: what is it?

The oval window in the heart is a developed intrauterine opening, covered with a special fold-valve, which is located on the septum between the atria. This window communicates between the right and left atria of the fetus during the embryonic period. Thanks to him, part of the placental blood enriched with oxygen can get from the right atrium to the left, bypassing the non-functioning lungs of the future baby. Thus, a normal blood supply to the head, neck, brain and spinal cord occurs.

During the first breath, the child's lungs and pulmonary circulation begin to function, and the need for communication between the right and left atrium loses its relevance. When the child inhales and the first cry of the child, the pressure created in the left atrium becomes higher than in the right, and, in most cases, the valve slams and closes the oval window. Subsequently, it is overgrown with muscle and connective tissue and disappears completely. But it happens that the oval window remains open. What is the threat of such a condition, how to correct it in a newborn and whether it needs to be done - this is what this article is about.

The oval window in 40-50% of full-term healthy newborns is anatomically closed by a valve already in the first 2-12 months of life, and its functional closure occurs at 2-5 hours of life. Sometimes it remains partially open or, under certain conditions (valve defect, strong crying, screaming, tension in the anterior abdominal wall, etc.) does not close. The presence of an open oval window after 1-2 years is considered a minor anomaly in the development of the heart (MARS syndrome). In some cases, the oval window can close at any other time and completely spontaneously. Among adults, it is observed in 15-20% of cases. Such a prevalence of this anomaly has become an urgent problem for cardiology and requires monitoring.

Causes

The exact reasons why the oval window does not close on time are modern medicine unknown, but, according to some studies, the presence of this anomaly can be triggered by a number of predisposing factors:

heredity;
congenital heart defects;
infectious diseases of the mother during pregnancy;
smoking and alcohol abuse by the mother or father;
drug addiction of parents;
phenylketonuria or diabetes from the mother;
taking certain medications during pregnancy (some antibiotics, lithium preparations, phenobarbital, insulin, etc.);
prematurity of the child;
connective tissue dysplasia, etc.

Symptoms

A child with an open oval window is restless, gaining weight poorly.

Normally, the size of the oval window in a newborn does not exceed the size of a pin head and is reliably covered by a valve that prevents the discharge of blood from the pulmonary circulation to the large one. With an open oval window ranging in size from 4.5-19 mm or incompletely closing it with a valve, a child may experience transient disorders cerebral circulation, signs of hypoxemia and the development of such severe complications as ischemic stroke, kidney infarction, paradoxical embolism and myocardial infarction.

More often, an open oval window in newborns is asymptomatic or accompanied by mild symptoms. Indirect signs this anomaly in the structure of the heart, by which parents may suspect its presence, can become:

the appearance of severe pallor or cyanosis during severe crying, screaming, straining or bathing the child;
restlessness or lethargy while feeding;
poor weight gain and poor appetite;
rapid fatigue with signs of heart failure (shortness of breath, increased heart rate);
predisposition of the child to frequent inflammatory diseases bronchopulmonary system;
fainting (in severe cases).

When examining while listening to heart sounds, the doctor can register the presence of "murmurs".

Possible complications

An open oval window in extremely rare cases can be complicated by the development of paradoxical embolism. Small gas bubbles, blood clots, or small pieces of adipose tissue can become emboli. When the oval window is open, they can enter the left atrium, then into the left ventricle. With the blood flow, an embolus can enter the vessels of the brain and cause the development of a heart attack or cerebral stroke: conditions that can be fatal. This complication appears suddenly and can be triggered by injury or prolonged bed rest during a period of serious illness.

Diagnostics

To confirm the diagnosis of "open oval window", the child should be examined by a cardiologist who will be able to evaluate the results of ultrasound of the heart and ECG. In newborns and children younger age transthoracic Doppler echo-KG is performed, which allows obtaining a two-dimensional image of the interatrial wall and valve movement in time, assessing the size of the oval window or excluding the presence of a defect in the septum.

After confirming such a diagnosis and in the case of excluding other heart pathologies, the child is recommended dispensary observation with the obligatory repeated ultrasound of the heart once a year to assess the dynamics of the heart anomaly.

Treatment

In the absence of pronounced hemodynamic disturbances and symptoms, an open oval window in a newborn can be considered a normal variant and requires only constant monitoring by a cardiologist. Parents are advised to walk more often with their child in the fresh air, perform exercise therapy and hardening procedures, follow the rules balanced nutrition and the regime of the day.

Drug therapy can only be indicated for children with signs of heart failure, transient ischemic attack ( nervous tic, asymmetry of facial muscles, tremors, convulsions, fainting) and, if necessary, prevention of paradoxical embolism. They can be prescribed vitamin-mineral complexes, preparations for additional nutrition of the myocardium (Panangin, Magne B6, Elkar, Ubiquinon) and antiplatelet agents (Warfarin).

The need to eliminate the open window in newborns is determined by the volume of blood discharged into the left atrium and its effect on hemodynamics. At minor violation blood circulation and the absence of concomitant congenital heart defects surgery not required.

In case of severe hemodynamic impairment, it may be recommended to conduct a low-traumatic operation for endovascular transcatheter closure of the opening with a special occluder. it surgery carried out under the control of X-ray and endoscopic equipment... A special probe with a "patch" -plaster is inserted into the right atrium through the femoral artery. Such a "patch" closes the gap between the right and left atrium and stimulates its overgrowth with its own connective tissue. After performing such an operation, the patient is recommended to take antibiotics for six months to prevent the occurrence of endocarditis. After that, the patient can return to normal life without any restrictions.

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

An open oval window is not so terrible diagnosis for the child and his parents

What is it

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

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

A small valve separates such a window from the left ventricle, which matures completely by the beginning of labor. When the baby takes the first breath and his lungs open, then blood rushes to them, which is accompanied by an increase in pressure inside the left atrium. At this moment, the oval window closes with a valve, and then it gradually grows together with the septum. If the window closes ahead of time, even in utero, it threatens heart failure and even the death of the child, so the presence of a hole is important for the fetus.

The window between the atria can close even by age 5

Closing the window happens differently for different children. In some, the valve grows to it immediately after birth, in others - during the first year, in others - by the age of 5. In some cases, the size of the valve is insufficient to close the entire oval window, which is why the opening remains slightly open for life, and blood in a small volume is periodically discharged from the small circle into the systemic circulation. This situation is observed in 20-30% of children.

A foramen ovale that has not completely closed after birth is not considered a defect in the septum that separates the atria, as the defect is much more serious. It is considered congenital malformation, and LLC is referred to as small anomalies, representing only an individual feature. With a defect in the septum, the valve is completely absent and blood can be discharged from left to right, which is a health hazard.

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

Causes

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

Poor environmental situation.
Nicotine.
Stress.
Narcotic substances.
Alcohol.
Medicines prohibited during pregnancy.
Malnutrition.

Quite often, the opening of the oval window is noted in children who were born much ahead of time, as well as in the presence of intrauterine growth retardation in term babies.

In the next video, you can see how the blood circulation and heart activity of a child should normally change before birth.

Symptoms

If an open valve is an isolated problem and the child has no other heart defects, clinical picture rather scarce. You can suspect LLC in a baby by:

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

Preschoolers and schoolchildren may have problems with exercise tolerance and frequent inflammatory diseases respiratory system.

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

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

Weakness.
Feelings of irregularities in the heart rate.
Increased fatigue.
Episodes of dizziness.
Periodically appearing unreasonable fainting.

Diagnostics

You can suspect the presence of LLC in a baby after listening to the heart with a stethoscope. If the doctor hears systolic murmurs, he prescribes an ultrasound scan for the child, since this method is most preferable to detect the oval window. Pathology is often detected during elective echocardiography performed at 1 month for all children. In some cases, to clarify the problem, the baby may be prescribed transesophageal ultrasound, as well as angiography.

Ultrasound signs of an open oval window are:

Size up to 5 mm.
Position in the middle of the septum.
Hole rendering inconsistency.
Finding a valve in the left atrium.
Thinned atrial septum.

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

Komarovsky's opinion

A well-known pediatrician confirms that the oval window is open in almost all newly born babies and in 50% of them it remains open until 2 years of age. But even at the age of 2 to 5 years, the presence of such a window in the heart is considered a variant of the norm, which practically does not affect the well-being and health of the child.

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

Treatment

If there is no pronounced clinic and there are no problems with the work of the heart, which is especially often the case with the presence of LLC, no drug treatment not required. The child is recommended measures that are important for the general strengthening of the body:

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

If there are complaints from the heart, children are prescribed drugs for myocardial nutrition and vitamins. Most often, babies are prescribed l-carnitine, ubiquinone, panangin and magne B6.

The most effective treatment OOO is an introduction to the right atrium of the patch

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

Forecast

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

If the foramen ovale remains open after the child is 5 years old, it is most likely that it will not overgrow and will remain in the child for the rest of his life. Moreover, such an anomaly has almost no effect on labor activity... It will become an obstacle only for obtaining the profession of a diver, pilot or astronaut, as well as for strong sports loads, for example, weightlifting or wrestling. At school, the child will be assigned to the second health group, and when a boy with LLC is called up, he will be counted in category B (there are restrictions in military service).

Many children with LLC feel quite healthy

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

Among the rare complications of PFOs in childhood, embolism may occur. This is the name given to the ingress of gas bubbles, particles of adipose tissue or blood clots into the bloodstream, for example, with injuries, fractures or thrombophlebitis. Emboli, when they enter the left atrium, travel to the vessels in the brain and cause brain damage, sometimes lethal.

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

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

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

General information

An open oval window is a congenital communication between the right and left atria, which is a residual element of the foramen ovale of the fetal heart. The atrial opening with a valve is laid in utero and is necessary condition functioning of cardio-vascular system during this period of development. Thanks to the open oval window, part of the placental oxygenated blood flows from the right atrium to the left, bypassing undeveloped, non-functioning lungs, and ensures normal blood supply to the neck and head of the fetus, the development of the brain and spinal cord.

In healthy full-term babies with normal conditions development, the open oval window usually closes and ceases to act in the first 12 months after birth. But its closure occurs individually for everyone: on average, by the age of 1 year, the oval window remains open in 40-50% of children. The presence of an open oval window after 1-2 years of a child's life is referred to as minor anomalies in the development of the heart (MARS - syndrome). In mature patients, an open oval window is detected in about 25-30% of cases. The fairly high prevalence of an open oval window determines the urgency of this problem in modern cardiology.

Reasons for an open oval window

All babies are born with an open oval window of the heart. After the first spontaneous inhalation in the newborn, the pulmonary circulation begins to fully function, and the need for an open oval window disappears. 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 partially closes or does not overgrow at all, and under certain conditions (with hacking cough, crying, screaming, tension of the anterior abdominal wall), blood is released 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, exposure to adverse factors can lead to an open oval window external environment, smoking and drinking alcohol by a woman during pregnancy. Due to genetic characteristics, the diameter of the valve may be less than the diameter of the oval opening, which will prevent it from completely closing.

An open oval window may accompany congenital malformations of the mitral or tricuspid valves, an open arterial duct.

Risk factors for opening the valve of the oval window can be significant physical activity in athletes involved in weightlifting, wrestling, and athletic gymnastics. The problem of an open oval window is especially urgent for divers and divers who dive to a considerable depth and have 5 times more high risk the development of decompression sickness. In patients with thrombophlebitis of the lower extremities or small pelvis with a history of pulmonary embolism, contraction of the vascular bed of the lungs can cause an increase in pressure in the right heart and the appearance of a functioning open oval window.

Features of hemodynamics with an open oval window

The open oval window is located at the bottom of the fossa oval on the inner left wall of the right atrium, often small (pinhead) and slit-shaped. The size of an open oval window is 4.5 mm on average, but can be up to 19 mm. The open oval window, in contrast to the defect of the interatrial septum, has a valve structure that ensures the inconstancy of the interatrial communication, the ability to discharge blood in only one direction (from the pulmonary circulation to the large one).

The clinical significance of an open oval window is controversial. An open oval window may not cause hemodynamic disturbances and may not cause negative impact on the patient's health due to its small size and the presence of a valve that prevents blood shunt from left to right. Most people with an open oval window are unaware of this anomaly and lead a normal life.

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

Symptoms of an open oval window

The open oval window has no specific external manifestations, in most cases proceeds latently, sometimes it can be accompanied by meager symptoms. Indirect signs of an open oval window may be: a sharp pallor or cyanosis of the skin in the area of the lips and nasolabial triangle during physical exertion (crying, screaming, coughing, straining, bathing the child); tendency to frequent colds and inflammatory bronchopulmonary diseases; slowing down of the child's physical development (poor appetite, insufficient weight gain), low endurance during physical exertion, combined with symptoms of respiratory failure (shortness of breath and tachycardia); sudden fainting and symptoms of cerebrovascular accident (especially in patients young age, with varicose veins, thrombophlebitis of the lower extremities and small pelvis).

Patients with an open oval window may be disturbed by 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 when moving to a horizontal position. Complications of an open oval window are rare. For a paradoxical embolism of cerebral vessels, aggravating this anomaly, a sudden development of neurological symptoms and a fairly young age of the patient are characteristic.

Open oval window diagnostics

The study of the anamnesis and physical examination of the patient often do not allow immediately determining the presence of an open oval window, but can only admit the possibility of this atrial septal anomaly (cyanosis of the skin, fainting, frequent ARVI, delayed development of the child). Auscultation helps detect the presence of a murmur as a result of an abnormal shunt of blood from a higher pressure chamber to a lower pressure chamber.

To establish accurate diagnosis open oval window are used instrumental research and imaging methods: ECG (at rest and after exercise), conventional and Doppler echocardiography, chest x-ray, probing of the cardiac cavities.

When the oval window is open, changes appear on the electrocardiogram, indicating an increase in the load on the right heart, especially on the right atrium. Older persons with an open oval window may show radiological signs an increase in the right chambers of the heart and an increase in blood volume in the vascular bed of the lungs.

In newborns and young children, transthoracic two-dimensional echocardiography is used, which allows to visually determine the presence of an open oval window and its diameter, to obtain graphic image movements of the valve leaflets in time, to exclude the defect of the interatrial septum. Doppler echocardiography in graphic and color mode helps to clarify the presence and size of an open oval window, to identify turbulent blood flow in the foramen ovale, its velocity and the approximate volume of the shunt.

In older children, adolescents and adults, for the diagnosis of an open oval window, a more informative transesophageal echocardiogram is used, supplemented by a test with bubble contrast and a test with straining (Valsalva test). Bubble contrast enhances the visualization of the open oval window, allows you to determine its exact dimensions, to assess the pathological blood shunt.

Most informative, but more aggressive method the diagnosis of an open oval window is heart sounding, which is carried out immediately before surgical treatment in a specialized cardiac surgery hospital.

An examination for the presence of an open oval window is necessary for patients with varicose veins, thrombophlebitis, cerebrovascular accident, chronic diseases lungs, which are at risk of developing paradoxical embolism.

Treatment of an open oval window

With an asymptomatic course, an open oval window can be considered a normal option. Patients with an open oval window in the presence of an episode of transient ischemic attack or stroke in history for the prevention of thromboembolic complications are prescribed systemic therapy anticoagulants and disaggregants (warfarin, acetylsalicylic acid). The method of monitoring anticoagulant therapy is the international normalized ratio (INR), which should be in the range of 2-3 when the oval window is open.

The need to eliminate the open oval window is determined by the volume of the shunted blood and its effect on the work of the cardiovascular system. With a small discharge of blood, the absence of concomitant pathology and complications, surgery is not required.

With a pronounced pathological discharge of blood from the right atrium to the left, a low-traumatic X-ray endovascular occlusion of the open oval window is performed. The operation is performed under X-ray and echocardioscopic control using a special occluder, which, opening up, completely clogs the hole.

Open oval window forecast

Patients with an open oval window are recommended regular observation by a cardiologist and echocardiography control. The performed endovascular occlusion of the open oval window allows patients to return to their usual 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 of endovascular closure of the open oval window was observed in patients with platypnea who had a pronounced shunt from right to left.

If a child over 2 years old has an opening in the interatrial septum, then this is a likely sign of an open oval window (OOO). Normally, it functions in the fetus, then overgrows. Children with this pathology lag behind in growth, they often develop cyanosis, shortness of breath, headache and sudden loss of consciousness. Treatment depends on the size of the defect. They use drugs and surgical methods.

Read in this article

What is an open oval window

LLC during the period of fetal formation is necessary, since through it the placental blood enters from the right into the left atrium, and not into the lungs. Thus, the blood supply to the brain, as well as the spinal cord, is carried out. The hole is located in the center of the septum and is equipped with a valve that inhibits the reverse flow of blood.

Fetal circulation

After the birth of LLC, all children have. But after the child begins to breathe on his own, the need for his existence disappears. The higher pressure in the left atrium pushes the valve down and it gradually builds up against the septum.

If there is an uncovered part, or the window is not completely covered, then, with strong cough or shouting, blood is dumped from right to left. The window can be open in half of children after one year and in a quarter of adults.

Reasons for the appearance of an open oval window

There is a hereditary predisposition to the formation of LLC. In case of a violation of the structure of the chromosome or defects in the genes, the valve is smaller in size than the value holes. Also, this pathology occurs with unfavorable factors:

premature birth;
violation of the structure of connective tissue;
congenital anomalies in the development of the heart: valvular defects and;
bad habits of the mother: smoking, drug addiction, alcoholism.

The window can be opened during scuba diving when diving to great depths (divers, divers), for professional weightlifters, wrestlers, when doing high-intensity strength sports. With vein thrombosis with blockage of the pulmonary artery, the pressure in the right heart rises, this provokes the opening of the hole.

Blood circulation with an open oval window

OOO has a size of about 5 mm and a slit appearance. Sometimes a hole with a diameter of about 2 cm can be found. Unlike a congenital septal defect, the window is covered with a valve. Therefore, a small discharge of blood may not appear in any way, and most people are unaware of its existence.

If the pressure in the pulmonary artery system is high, then OOO compensates for it and is considered a favorable sign for life expectancy. With a significant flow of venous blood from the right atrium in patients, the oxygen content in the tissues decreases, and circulatory disorders of the brain and myocardium occur.

Signs and symptoms of an open oval window

Manifestations of LLC are not specific, in most cases they do not have clinical symptoms, therefore, the diagnosis is made with a delay.

Symptoms in children

An indirect evidence of pathology may be a sharp pallor or bluish color of the skin during a crying baby, screaming or bathing. Due to insufficient
oxygen supply to the tissues occurs:

frequent bronchitis, colds;
poor appetite;
lag in weight gain;
physical development is slowed down;
dyspnea;
episodes of loss of consciousness.

Signs of LLC in adults

Patients are worried about headache, migraine attacks, dizziness. At the same time, in a standing position, shortness of breath and palpitations increase, and with the transition to a horizontal position, they weaken. Young people show signs of impaired blood supply to the brain, up to strokes.

Why the open oval window did not close in the child

If, as the heart grows, the valve overlapping the oval window does not increase, then a dense overlap of the opening does not occur. Ultimately, blood flows from one atrium to another, creating an increased load.

I can lead to the occurrence of pathology conditions that contribute to an increase in pressure in the right atrium: lung diseases, combined heart defects, developmental disorders of the venous system.

The danger posed by an open oval window

Minor defects do not pose a threat to health, but if the patient has other abnormalities of the valvular apparatus of the heart or vascular development, then the venoarterial shunt of blood can impair the movement of blood within the heart.

Kidney infarction

This condition is especially dangerous in the presence of increased thrombus formation in the veins of the lower extremities. Microthrombi, falling into the left atrium, with arterial blood are carried to all organs and, under the influence of pressure, clog the lumen of the vessels, causing acute violation blood supply - ischemia. This increases the risk of serious complications:

stroke;
cardiac ischemia of varying severity;
kidney infarction.

For information on the danger of LLC for children and adults, diagnostics and patient management tactics, see this video:

When the open oval window closes normally

Usually in a newborn, the window valve is compressed high blood pressure in the left atrium. This happens after the lungs have completely opened - within 3 to 5 hours. The overgrowth of the hole usually lasts from 2 to 11 months. In some children, the oval window does not overlap by only two years of age. This is considered one of the options for the norm. If after five years there is an LLC, then there is no independent closure.

Diagnostics of the open oval window in a child

In order to make a diagnosis, they study the history of the appearance of complaints and their severity, but since they do not have characteristic features, then the assumption about LLC can be confirmed using instrumental methods.

Inspection

The child may be stunted, the weight is reduced, the skin is pale, when crying or straining, the nasolabial triangle and lips turn blue. Usually, on auscultation, a murmur can be detected due to the transition of blood between the cavities of the heart: from a higher pressure to a lower one.

Ultrasound

In the study, you can identify the hole and the valve that closes it. The volume and direction of blood flow, the presence of other anomalies of the heart and blood vessels are determined. The following signs are typical for LLCs:

Size from 2 to 4.5 mm.
The valve is visible in the left atrium.
The window is located in the middle of the partition.
Near the hole, the walls are thin (with a defect, the partitions are thickened).

Echocardiography

A two-dimensional echocardiogram shows the diameter of the open window and the movement of the valve, it can help distinguish this pathology from other heart defects. This method helps to identify the presence of turbulent blood flow, its volume and velocity. For LLC diagnostics, this is the most informative way.

If there are circulatory disorders, then you can not take part in competitions, the loads must be determined by a cardiologist after functional tests.

It can be concluded that the presence of an open window does not lead to a violation of well-being with a small size and the absence of excessive physical exertion, therefore, treatment is not required. If there is a large defect, then it is eliminated using endovascular methods.

what is the correct name for the "hole in the heart" disease?

what is the correct name for the "hole in the heart" disease? how dangerous is it for life and how does it radiate? Answers:

Reflexology and computerized reflexodiagnostics using the "riodaraku" method

Occupation: Healers, Alternative Medicine, Doctors
Answer:
"A hole in the heart" is probably literal translation... In Russian, such a diagnosis sounds like "heart disease". Defects are congenital and acquired and are characterized by openings (perforations) of the heart valves, the interventricular or chair septa, large coronary blood vessels, and the ascending aortic arch. In the recent past, many heart defects have led to disability and death of patients. Currently, high open-heart cardiac surgery technology in combination with the developed successful methods of vascular, tissue and stem cell implantation makes it possible to overcome the most severe heart defects.

Graphology in Israel, graphology, training in graphology

Occupation: Psychologists, Courses, Schools and Seminars, Lawyers and Notaries
Answer:
It most likely could be a prolapse. mitral valve... It can be of an undefined cause, or it can be acquired - as an accompaniment to some other disease.

Most often, we are talking about hemodynamically insignificant mitral valve prolapse, which is not dangerous, but it is best to verify this with your doctor.

International business with an American company in the Wellness industry - healthy lifestyle

Type of activity: Sales of cosmetics, Network marketing
Answer:
Vika!
If it is in a child, then there are not enough substances in the diet. This is successfully solved by dietary supplements - biologically active additives High Quality.
The highest quality in the world is from my American manufacturing company. One boy, my client, about 5 years old, had this hole overgrown after 3 weeks. He was eating a baby supplement with vitamins and minerals.
Doctors will offer you an operation. Everyone wants to earn money. What is best for you is up to you. Only you first look on the Internet how heart surgery is done.
If then the child continues to eat dietary supplements for prophylaxis, he will live for 120 years and will not get sick. He will be the best student at school and will fully realize his genetic potential.
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