Open oval window of the heart. Open foramen ovale in the heart: causes, symptoms, treatment and prognosis. The oval window does not close on its own, what are the reasons?

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

A patent foramen ovale is not such a terrible diagnosis for a child and his parents

What is this

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

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

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

The window between the atria can close even by age 5

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

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

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

Causes

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

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

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

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

Symptoms

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

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

Preschoolers and school-age children may have problems with exercise tolerance and frequent inflammatory diseases of the respiratory system.

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

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

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

Diagnostics

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

Ultrasound signs of an open oval window are:

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

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

Komarovsky's opinion

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

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

Treatment

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

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

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

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

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

Forecast

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

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

Many children with LLC feel quite healthy

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

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

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

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

Modern diagnostic procedures are able to identify even minor deviations and anomalies in the structure of organs and tissues of the body. Such opportunities help to begin the necessary treatment in a timely manner.

However, there are many conditions whose detection does not require immediate therapy or surgery. This is worth remembering for young parents who fall into a kind of panic when informed that there is a small hole at the site of the fetal message in the heart of a newborn baby.

Often, when explaining the diagnosis, this is called a patent oval window.

Anatomical background

The intrauterine period of its development unborn child spends in amniotic fluid.

Accordingly, there is no need for active breathing, and the lungs are in a closed state. The baby receives oxygen through the umbilical vessels from the mother.

The heart initially consists of 4 chambers and is ready to work on both circulations, but the lung tissue does not function. Therefore, the right ventricle is practically switched off from activity, and for the life support and development of fetal organs, nature provides for the discharge of oxygenated blood from the right atrium to the left and further along the systemic circulation to all structures.

This interatrial communication is called the oval window or foramen (foramen ovale).

Is it pathological?

With the birth of the baby and the first cry (inhalation), the lungs expand, the pressure gradient between the chambers of the heart changes, and the fetal window slams shut. Subsequently, connective tissue grows in this place, leaving only a hole.

There are many situations where the closing process is delayed. The hole remains open until 2 years of age in 50% of children, and up to 5 years in 25% of children. Approximately every fourth to sixth adult in the population can live peacefully, unaware of the presence of such an anomaly in the heart.

Based on various studies, doctors agreed that the fundamental criterion for alertness in the presence of communication between the atria is not the fact of the presence of a defect, but the age of the patient, the clinical picture and the size of the open opening itself.

When should you not worry?

If the hole in a newborn in the area of ​​the oval window has a diameter of up to 7 mm, there are no manifestations of disorders, then cardiac intervention is not resorted to. The baby is observed at the prescribed time. After a certain amount of time, a repeat echo-CG is performed to assess the dynamics of the size of the open window.

If the hole does not close in the first months and has borderline dimensions (5–6 mm), the doctor may prescribe drugs that improve metabolism in the heart, vitamins and restorative procedures. Such drug support, good organization of the daily routine and nutrition help speed up the process of overgrowth of the small communication between the atria.

Possible signs

An open oval window can manifest itself as cyanosis of the nasolabial triangle during feeding, crying of the baby, or straining while passing stool. The child does not gain enough weight, is capricious, and does not breastfeed well.

Quite often, the fetal opening between the atria becomes a finding only when listening to heart sounds and/or performing an echocardiogram. At the same time, there are no complaints from the parents of the baby.

Preventive measures

An open oval window of small size is considered a normal variant until a certain age of the child. As the baby grows, the hole should close on its own.

Genetic malfunctions or disruption of intrauterine ontogenesis can become a reason that interferes with the normal growth and functioning of the unborn child. That is why, while carrying a baby, a mother should think about proper diet nutrition, daily routine, use of vitamins and minerals, it is also important to follow the recommendations of the obstetrician-gynecologist.

Surgical treatment

If the oval window has hemodynamically significant dimensions (with mixing of blood), there is no decrease in the lumen of the communication over time, the child is referred for consultation to a cardiac surgeon.

New techniques make it possible to quickly and minimally invasively install a special “shutter” (occluder). Through a small puncture in the femoral vessel, under hardware control with the help of a guidewire, a synthetic implant is brought to the interatrial septum, which closes the existing fetal communication.

Forecast

Most identified cases of PFO in newborns subsequently regress and end with complete closure of the interatrial communication in the first 2–5 years of life, without causing obvious reasons for concern.

An open foramen ovale, which is small in size, is already considered in older children as MARS (minor anomaly of cardiac development), and can limit excessive physical activity and extreme sports for them.

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The gap in the wall between the right and left atria is the patent foramen ovale. Let's consider the causes and pathogenesis of this phenomenon, methods of treatment and prevention.

According to international classification diseases ICD-10, congenital communication between the right and left atria is included in class XVII: Q00-Q99 Congenital anomalies (malformations), deformations and chromosomal disorders.

Q20-Q28 Congenital anomalies of the circulatory system.

Q21 Congenital anomalies (malformations) of the cardiac septum.

• Q21.1 Atrial septal defect:
  • Coronary sinus defect.
  • Unclosed or preserved: foramen ovale, secondary foramen.
  • Venous sinus defect.

The heart has a complex structure and performs many important functions. The organ contracts rhythmically, ensuring blood flow through the vessels. It is located behind the sternum in the middle part of the chest cavity and is surrounded by the lungs. Normally, it can shift to the side, as it hangs on the blood vessels and has an asymmetrical localization. Its base is turned toward the spine, and its apex faces the fifth intercostal space.

Anatomical features of the heart muscle:

• The adult heart consists of 4 chambers: 2 atria and 2 ventricles, which are separated by septa. The walls of the ventricles are thickened, and the walls of the atria are thin.
• The left atrium contains the pulmonary veins, and the right atrium contains the hollow veins. The pulmonary artery emerges from the right ventricle, and the ascending aorta emerges from the left ventricle.
• The left ventricle and left atrium are the left section in which arterial blood is located. The right ventricle and atrium are the venous heart, that is, the right department. The right and left parts are separated from each other by a solid partition.
• The left and right chambers are separated by the interventricular and interatrial septum. Thanks to them, blood from different departments hearts do not mix with each other.

Incomplete fusion of the septum is a congenital anomaly, that is, a residual element of embryonic development. In essence, it is a hole between the two atria, through which, during contractions, blood is thrown from one ventricle to another.

The interatrial foramen with the valve develops in utero and protrudes a necessary condition normal operation cardiovascular system at this stage of development. It allows some of the placental and oxygenated blood to pass from one atrium to the other without affecting the undeveloped and non-functioning lungs. This ensures normal blood supply to the fetal head and neck, as well as the development of the spinal cord and brain.

At the first cry of a newborn, the lungs open and a significant increase in pressure in the left atrium occurs. Thanks to this, the valve completely closes the embryonic gap. Gradually, the valve tightly fuses with the walls of the interatrial septum. That is, the gap between the right and left atrium closes.

In approximately 50% of cases, valve accretion occurs in the first year of the baby’s life, but in some cases by 3-5 years. If the valve size is small, the gap does not close and the atria are not isolated. This pathology is classified as MARS syndrome, that is, a minor anomaly of heart development. In adult patients this problem occurs in 30% of cases.

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ICD-10 code

Q21.1 Atrial septal defect

Epidemiology

Medical statistics indicate that a patent foramen ovale (PFO) in the heart is prevalent in two age categories:

• This is normal in children under one year of age. When performing an ultrasound, an anomaly is detected in 40% of newborns.
• In adults, this heart defect occurs in 3.6% of the population.
• In patients with multiple heart defects, PFO is diagnosed in 8.9% of cases.

In 70% of cases, incomplete fusion of the septum is detected in infancy. In 30% of adults, this disorder manifests itself in the form of a channel or shunt that provokes various diseases from the cardiovascular system. In healthy and full-term children, the hole closes by 50% in the first year of life.

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Causes of a patent oval window

In most cases, the causes of a patent oval window are associated with genetic predisposition. As a rule, the anomaly is transmitted through the maternal line, but can also occur due to other reasons:

• Birth of a premature baby.
• Bad habits of the mother during pregnancy (alcohol, drug addiction, smoking).
• Congenital defects of the heart muscle.
• Toxic drug poisoning during pregnancy.
• Central nervous system disorders: severe stress and nervous experiences, emotional exhaustion.
• Connective tissue dysplasia.
• Unfavorable environment.
• Poor nutrition during pregnancy.

Very often, pathology is detected in other pathologies of heart development: open aortic duct, congenital defects of the mitral and tricuspid valves.

Risk factors

Atrial septal defect occurs for various reasons. Risk factors for the pathological condition are most often associated with genetic disorders through the first line of kinship.

The appearance of the disorder is facilitated by:

• Increased physical activity (strength sports, diving, weightlifting, etc.).
• Pulmonary embolism in patients with thrombophlebitis of the lower extremities and pelvic organs.
• Bad habits of women during pregnancy.
• Toxic poisoning.
• Premature birth.
• Reduced immune status women.
• Poor ecological environment.
• Deficiency of vitamins and minerals in female body during pregnancy due to poor nutrition.

In addition to the above factors, the disorder can be provoked high blood pressure on the right side of the heart muscle.

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Pathogenesis

The mechanism for the development of a through hole between the atria is associated with many reasons. The pathogenesis of the anomaly is based on the interaction of internal and external factors. In most cases, these are deviations in the formation, that is, connective tissue dysplasia. Violation leads to involvement in pathological process heart valves, subvalvular apparatus and cardiac septum.

As the newborn's lungs expand and pulmonary blood flow increases, pressure increases in the left atrium, which helps close the gap. But connective tissue dysplasia interferes with this process. If primary pulmonary hypertension is diagnosed against this background, then the pathology has a favorable prognosis, increasing the patient’s life expectancy.

Hemodynamically insignificant patent foramen ovale

The movement of blood through the vessels is associated with the difference in hydrostatic pressure in different areas circulatory system. That is, blood moves from an area of ​​high pressure to low. This phenomenon is called hemodynamics. An open fissure in the wall between the right and left atria is located at the bottom of the oval socket on the inner left wall of the right atrium. The hole has small dimensions from 4.5 mm to 19 mm and, as a rule, has a slit-like shape.

A hemodynamically insignificant patent foramen ovale is an anomaly that does not cause circulatory disturbances and does not affect the patient’s health. This is observed if the defect is small in size and has a valve that prevents the blood from shunting from left to right. In this case, people with pathologies do not suspect its presence and lead a normal lifestyle.

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Symptoms of an open oval window

In most cases, there are no symptoms of a patent oval window. A person learns about the presence of pathology by chance during a routine examination. But the latent course of the disease has a characteristic symptom complex that can remain without proper attention for a long time:

• Cyanosis and increased pallor of the nasolabial triangle during physical activity.
• Tendency to colds and bronchopulmonary pathologies of an inflammatory nature.
• Slow physical development.
• Slow weight gain in a child.
• Poor appetite.
• Respiratory failure.
• Sudden fainting.
• Signs of cerebrovascular accident.
• Frequent headaches and migraines.
• Postural hypoxemia syndrome.

The presence of the above symptoms requires careful diagnosis and medical care. If various neurological disorders are observed, this may indicate complications of the disorder due to its prolonged course.

First signs

The congenital communication between the right and left atria has no specific manifestations. The first signs in most cases go unnoticed. A problem is suspected in the following cases:

• Severe headaches and dizziness.
• Blue lips during coughing and during any other physical activity.
• Predisposition to inflammatory lesions of the respiratory system.
• Severe respiratory failure during physical exertion.
• Fainting state.
• Varicose veins and thrombophlebitis of the lower extremities at a young age.

LLC has minimum radiographic symptoms, allowing one to suspect an anomaly: an increase in blood volume in the vascular bed of the lungs and an increase in the right side of the heart.

Patent foramen ovale in adults

The main vital organ of any living creature is the heart. In humans, it has a complex structure and is responsible for many functions. The organ includes the left/right ventricles and atria, connected by special valves. A patent foramen ovale in an adult is a pathology that is most often diagnosed in newborns and premature babies.

In adulthood, the unclosed hole is a shunt. Its presence can cause changes in the cardiovascular system and lungs due to the difference blood pressure in the atria. But the presence of this anomaly is not always a cause for concern. Very often people live fully and are not aware of the violation. Only an ultrasound can identify the problem.

The proper functioning of the heart and the body as a whole depends on the size of the defect. The hole size can be from 2 mm to 10 mm.

• If the window opens by 2-3 mm, but is not accompanied by deviations from the cardiovascular system, then this condition does not affect the functioning of the body.
• If the through hole is 5-7 mm, then this indicates that the disorder is hemodynamically insignificant. The deviation manifests itself only with increased physical activity.
• If the dimensions are 7-10 mm, then the patient is diagnosed with a gaping open window. In terms of its symptoms, this type of disease is similar to congenital heart disease.

Inferiority LLC usually does not have specific symptoms. The doctor can only guess about the causes of the painful condition. To identify the disorder, a comprehensive diagnosis is indicated. The presence of clinically insignificant symptoms at first glance is also taken into account:

• Blue discoloration of the nasolabial triangle during inflammatory diseases and after physical exertion.
• Frequent fainting.
• Varicose veins and thrombophlebitis.
• Shortness of breath.
• Predisposition to colds.
• Tachycardia.
• Migraine.
• Increased blood volume in the lungs.
• Frequent numbness of the limbs and impaired body mobility.

This disorder is diagnosed in 30% of people and persists from birth. But the risk of developing the disease increases significantly in athletes and with increased physical activity. The risk group includes: divers and divers, patients with PE (pulmonary embolism) and thrombophlebitis.

Treatment of the painful condition depends on its severity. Many adults are prescribed a range of preventive methods. In especially severe cases, it is indicated not only drug therapy, but also surgical intervention.

Stages

An open gap in the wall between the right and left atrium is a cardiovascular defect. The stages of the pathology are distinguished by the degree of organ damage and the nature of the resulting symptoms. IN medical practice There is such a thing as MARS syndrome (minor anomalies of cardiac development), which includes this disorder. The group of pathologies includes disorders of the development of external and internal structure cardiac muscle and adjacent vessels.

Incomplete fusion of the septum is included in the general classification of MARS syndrome:

1. Location and shape.

• Atria:
  • Open oval window.
  • Enlarged Eustachian valve.
  • MPP aneurysm.
  • Prolapsing valve of the inferior vena cava.
  • Trabeculae.
  • Prolapsed pectineus muscles in the right atrium.
• Tricuspid valve - displacement of the septal leaflet into the cavity of the right ventricle, dilatation of the right AV orifice, protrusion of the tricuspid valve.
• Pulmonary artery – prolapse of the pulmonary valve leaflets and dysplasia of its trunk.
• Aorta – borderline wide/narrow aortic root, bicuspid valve, sinus dilatation, valve leaflet asymmetry.
• Left ventricle – small aneurysm, trabeculae, chords.
• Mitral valve.

1. Causes and conditions of occurrence.

• Connective tissue dysplasia.
• Autonomic dysfunctions.
• Ontogenesis.
• Cardiogenesis disorders.

1. Possible complications.

• Heart rhythm disturbances.
• Pulmonary hypertension.
• Infectious endocarditis.
• Cardiohemodynamic disorders.
• Fibrosis and calcification of valve leaflets.
• Sudden death.

Any form or stage of MARS syndrome is a variant of visceral connective tissue dysplasia. It is characterized by a high frequency of changes in the central nervous system and neurovegetative disorders.

After establishing the type of anomaly, hemodynamic disturbances and regurgitation and their severity are identified. In 95% of cases, hemodynamic disturbances and side symptoms do not occur. As they grow older, structural abnormalities disappear.

Forms

Normally, a patent foramen ovale is temporary, as it is necessary to oxygenate the fetus during embryonic development. That is, the anomaly exists in all children, but by the time of birth it heals, since there is no need for additional oxygen saturation, since the lungs begin to work.

Types of incomplete fusion of the septum depend on the size of the hole:

• 2-3 mm is the norm, which does not cause deviations or consequences.
• 5-7 mm – the features of this pathology depend on the presence of concomitant provoking factors.
• >7 mm is a gaping hole requiring surgical treatment. According to studies, the maximum size may exceed 19 mm.

In addition to the oval window, there are other cardiac septal defects. Their differences are that the window has a valve responsible for regulating blood flow. LLC is not a heart defect, but refers to minor anomalies in the development of the cardiovascular system.

Patent foramen ovale with reset

In most cases, a through hole between the atria does not cause serious concerns. Since the pressure in the left atrium is higher than in the right, the valve between the septa is kept closed. This prevents blood from shunting from the right atrium to the left. As a rule, this is observed with window sizes of no more than 5-7 mm.

An open foramen ovale with discharge indicates a large pathology. This is observed with a temporary increase in pressure in the right atrium due to straining, physical exertion, crying or prolonged nervous tension. This condition causes the discharge of venous blood through the LLC, manifested by temporary cyanosis of the nasolabial triangle and blanching of the skin.

The disorder can lead to complications such as paradoxical embolism. Blood clots, gas bubbles, emboli, foreign bodies from the right atrium, entering the left atrium and continuing further movement, they can reach the vessels of the brain. This leads to the development of stroke, thrombosis and heart attacks. To prevent such disorders, comprehensive diagnosis and timely treatment should be carried out.

Patent foramen ovale with left to right shunt

A short channel between the right and left atria, covered by a valve and with abnormal blood circulation, is a patent foramen ovale with a left-to-right shunt. Normally, fluid discharge occurs in one direction - from right to left. LLC is a physiological feature of the body that is necessary during embryonic development. But after birth, the need for it disappears and the gap closes, as the lungs begin to work.

The following types of functioning of the oval window are distinguished:

• No hemodynamic reset.
• With right-left reset.
• With left-right reset.
• With biderectoral bypass.

LLC with left-right shunting indicates that the pressure in the right atrium is less than in the left. The main causes of this form of disorder include:

• Perforation of the oval window flap.
• Valve deficiency due to left atrium enlargement
• Valve failure.

Right-left shunting, when the pressure in the right atrium is greater than in the left, occurs due to the following reasons: prematurity and low body weight, increased physical activity and psycho-emotional disorders, neonatal pulmonary hypertension, respiratory distress syndrome.

Patent foramen ovale without signs of embolic activity

A patent foramen ovale is a valve communication between the atria. In the embryonic period, it is responsible for the passage of arterial blood into the left atrium from the right, without affecting the undeveloped vessels of the lungs. In most people, the PFO closes after birth, but in 30% it remains open, causing various pathological symptoms.

With this minor cardiac anomaly there is a high risk of paradoxical embolism. The pathology leads to the fact that small gas bubbles and blood clots enter the left atrium and through the left ventricle with the blood flow into the brain. Blockage of blood vessels in the brain provokes a stroke.

A patent foramen ovale without signs of embolic activity and other pathologies can be regarded as a variant of the normal structure of the heart. But in the presence of provoking factors ( physical activity, straining, coughing) the pressure in the right atrium increases and a right-to-left shunt occurs, causing a paradoxical embolism.

Complications and consequences

Absence timely diagnosis and treatment of the through hole of the atrium, is the main cause of the development of various consequences and complications. Patients may experience the following problems:

• Heart rhythm disturbances.
• Cerebrovascular accident.
• Pulmonary hypertension.
• Paradoxical embolism.
• Fibrosis and calcification of the valve leaflets of the heart muscle.
• Cardiohemodynamic disorders.
• Heart attack.
• Stroke.
• Sudden death.

According to medical statistics, the above complications are extremely rare.

Is a patent oval window dangerous?

Many experts consider the congenital communication between the right and left atria to be normal. Whether a patent foramen ovale is dangerous depends entirely on the general health of the patient and the presence of concomitant pathologies.

If the window is small, then as a rule it is not a cause for concern. The patient is prescribed regular examinations by a cardiologist, annual planned ultrasounds of the heart and a set of preventive measures. In the presence of concomitant diseases, LLC can cause serious changes in the cardiovascular system. This is due to the transfer of blood from the right atrium to the left, bypassing the lungs. In this case, any physical activity can cause various complications.

This congenital anomaly is dangerous due to the development of embolism. This is a condition when blood clots, gas bubbles and bacterial microorganisms enter the venous blood into the arterial blood, and through the left side of the heart into the arteries internal organs. In this case they may be affected coronary arteries, kidneys, spleen, limbs. Heart rhythm disturbances are dangerous due to strokes and heart attacks.

Diagnosis of an open oval window

Minor cardiac anomalies are characterized by a latent, that is, hidden course. Pathology can be suspected if there is characteristic symptoms or during a routine examination of the body. Diagnosis of an open oval window is carried out using the following methods:

1. Taking an anamnesis - the doctor asks about the presence of genetic abnormalities among relatives, about the course of pregnancy, the woman’s bad habits and drug treatment during pregnancy, and the patient’s degree of physical activity.
2. External examination - this method is ineffective, since LLC does not always make itself felt with clearly expressed symptoms. But blueness of the nasolabial triangle during crying and straining, pallor of the skin, poor appetite and retardation in physical development, allow one to suspect a disorder.
3. Laboratory research– to date, there are no genetic tests that would identify MARS syndrome in newborns. Patients are prescribed the following tests:

• General and clinical analysis blood.
• Prothrombin gene mutation.
• Prothrombin time.
• Factor V (Leiden).
• Determination of homocysteine ​​and antithrombin levels.
• Determination of protein C and protein S levels.

1. Instrumental studies - for diagnosis, auscultation is carried out, that is, listening chest for the presence of systolic murmurs. The patient is prescribed cardiac ultrasound, echocardiography, angiography, MRI and a set of other procedures.

During diagnosis, the doctor conducts a nutritional assessment, identifies eating disorders and symptoms of abnormalities associated with an imbalance of consumed nutrients. The environmental features of the patient’s living environment are also taken into account.

Noise when the foramen ovale is open

One of the methods for diagnosing a through hole between the atria is to listen to the chest using a phonendoscope. When the cardiovascular system operates, peculiar tones arise. The heart pumps blood, and valves regulate its direction.

• Before the heart contracts, the valves between the atria and ventricles close.
• Blood from the left ventricle enters the aorta, and from the right into the pulmonary artery. When this happens a tone is formed.
• The tone occurs when the valves close, if some kind of obstruction forms in the heart, and due to many other factors.

A murmur with an open foramen ovale cannot always be detected using a phonendoscope. This is due to the fact that the pressure difference between the atria is small, so the vortex flow characteristic of the anomaly may not form.

Heart murmur can be: soft, rough, blowing. All noises are divided into the following groups:

• Pathological – often the first, and sometimes the only sign of abnormalities of the cardiovascular system.
• Healthy - associated with the growth characteristics of the chambers and vessels of the heart, the structural features of the organ.

To determine the nature of the noise and the reasons for its occurrence, the doctor performs echocardiography and ultrasonography. These methods allow you to evaluate the structure of the heart and surrounding vessels and tissues.

Instrumental diagnostics

Examination of the body using special equipment is instrumental diagnostics. If an incomplete fusion of the heart septum is suspected, the following studies are indicated:

• X-ray – detects possible heart problems caused by increased blood pressure in the right ventricle due to an atrial septal defect.
• Heart ultrasound is performed to determine the boundaries of the LLC and its size. Prescribed for newborns and older patients.
• Echocardiography is performed if various cardiac anomalies are suspected. Allows you to identify pathology even if it is hidden. It is carried out in two states: after physical activity and during calm.
• Transthoracic two-dimensional echocardiography - allows you to identify the inferiority of the oval window valve in newborns. Visualizes the movement of the valve leaflets, determines the speed and volume of blood flow from one atrium to another.
• Transnutritive echocardiography is prescribed if an abnormality is suspected in older children and adolescents. During the examination, an endoscope is immersed into the esophagus, bringing it as close as possible to the heart muscle. To get more reliable results Bubble contrast may be prescribed.
• Cardiac probing is one of the most accurate, but aggressive diagnostic methods. Most often used before surgical interventions. The procedure involves advancing a probe through the arterial bloodstream to the heart for detailed visualization.

According to the results instrumental diagnostics a final diagnosis may be made or additional studies may be ordered.

Patent foramen ovale on ultrasound

Ultrasound examination of the cardiovascular system is one of instrumental methods to identify both congenital and acquired anomalies among newborns and older patients.

An open foramen ovale on ultrasound is characterized by the following symptoms:

• Enlargement of the right cardiac chamber.
• Small hole sizes - from 2 to 5 mm.
• Displacement of the main septum between the atria towards the right atrium.
• Thinning of the walls of the interatrial septum.

Using ultrasound, it is possible to visualize the valves in the cavity of the left atrium, assess the general condition of the organ and the volume of blood flow, localization and other features of the pathology.

Sonographic signs of an open oval window

Echocardiography is a diagnostic method using ultrasound waves. It is used to study and determine the localization of internal organs and structures.

Sonographic signs of a patent foramen ovale can be detected immediately after birth using the following studies:

• Contrast echocardiography - reveals PFO or atrial septal defect of the smallest size. For diagnosis, the patient is given an intravenous injection with saline solution. If there is a gap, tiny air bubbles will penetrate through it from the right atrium to the left.
• Transthoracic two-dimensional echocardiography (EchoCG) - visualizes not only the opening, but also a functioning valve. This method is especially informative in newborns and early childhood patients.

In addition to the above methods, bubble-enhanced transesophageal echocardiography may be prescribed to determine the echographic signs of the disorder.

Dimensions of the open oval window

You can suspect minor cardiac anomalies using their characteristic symptoms, which very often occur in a latent form. The size of the open oval window and the presence of concomitant diseases affect the severity of pathological signs of the disease.

An open gap in the wall between the right and left atria can have the following dimensions:

• 2-3 mm is considered normal and does not cause any symptoms or complications.
• 5-7 mm is a small size of the anomaly. When exposed to certain factors, it causes a number of unpleasant symptoms, which can progress without medical diagnosis and treatment.
• 7 mm or more is a large or gaping window that requires surgical treatment. In rare cases, it can reach maximum sizes of more than 19 mm.

According to studies, in approximately 40% of adults, the opening between the atria is not tightly closed. The average gap size is 4.5 mm. If the window remains completely open, then atrial septal defect is diagnosed, which, unlike PFO, is characterized by the absence of a working valve.

Open oval window 2, 3, 4, 5 mm

Congenital communication between the right and left atria is very often diagnosed in premature newborns and slightly less often in healthy children. An open oval window of 2, 3, 4, 5 mm is considered normal, but under the influence of certain factors it can cause pathological symptoms.

Holes larger than 5 mm occur with characteristic signs that allow one to suspect a violation:

• Blueness of the nasolabial triangle during physical activity, crying, screaming.
• Slowing down the mental and physical development.
• Loss of consciousness and dizziness.
• Fast fatiguability.
• Presence of a heart murmur.
• Various disorders of the respiratory system.
• Frequent colds.

The appearance of the above symptoms is a reason to immediately consult a cardiologist. After a complex of various diagnostic measures, the doctor will prescribe treatment and give recommendations for correcting the disease.

Differential diagnosis

Abnormal valve communication between the atria requires comprehensive research and treatment if necessary. Differential diagnosis of an open oval window is carried out with pathologies with similar symptoms.

First of all, differentiation is necessary with other interatrial communications:

• Atrial septal defect.
• Aneurysm of the interatrial septum.
• Hemodynamic discharge disorders.

Let's take a closer look at the differences between congenital communication between the right and left atria and atrial septal defect:

Based on the results of the studies, the doctor makes a final diagnosis or prescribes additional examinations/tests.

Treatment of open oval window

Such a minor cardiac anomaly as a through hole between the atria requires special attention. Treatment for an open oval window depends on many factors:

• Dimensions and clinical significance of the gap.
• Fluctuations in the size of the shunt during physical activity.
• Features of the septum (increased extensibility, loss of contractility).
• The degree of increase in pressure in the pulmonary artery.
• Enlargement of the right side of the heart.
• Risk of embolic/cerebral complications.
• Presence of concomitant diseases.
• General condition of the body.

Treatment tactics are entirely based on the presence or absence of LLC symptoms:

1. If there are no symptoms, therapy is not required. The patient is recommended to be monitored by a therapist/pediatrician and a cardiologist, and periodically assess the dynamics of the anomaly using ultrasound. If there is a risk of complications (stroke, heart attack, ischemia, lesions of the veins of the lower extremities), then patients are prescribed medications for blood thinning (Warfarin, Aspirin and others).
2. In the presence of pain symptoms, not only medication is indicated, but also surgery. In case of pronounced right-to-left shunting and the risk of embolism, the defect is closed using an occluding device or a special absorbable patch.

Elkar with an open oval window

One of the methods of treating MARS syndrome is drug therapy. Elkar is prescribed for open foramen ovale from the first days of the disease. Let's consider more detailed instructions this drug and features of its application.

Elkar is medicine, used to correct metabolic processes in the body. The drug contains L-carnitine, an amino acid whose structure is similar to B vitamins. It participates in lipid metabolism, stimulates enzymatic activity and the secretion of gastric juice, and increases resistance to physical stress.

The active component regulates glycogen consumption and increases its reserves in the liver and muscle tissue. It has pronounced lipolytic and anabolic properties.

• Indications for use: improvement of the condition of premature babies and newborns after birth injuries, asphyxia. Prescribed for weak sucking reflex, low muscle tone, poor development of mental and motor functions, with insufficient body weight. The drug is used in the complex therapy of chronic gastritis and pancreatitis, and for dermatological diseases. Accelerates the recovery of the body under intense physical and psycho-emotional stress, with reduced performance and increased fatigue.
• Directions for use: the medicine is taken orally 30 minutes before meals. The dosage and course of treatment are individual for each patient and are therefore determined by the attending physician.
• Side effects: isolated cases of dyspeptic disorders, myasthenia gravis, gastralgia, systemic allergic reactions have been recorded.
• Contraindications: hypersensitivity to the components of the drug. If the medicine is prescribed for patients under 3 years of age, careful medical supervision is required. Not used for the treatment of pregnant women and during lactation.
• Overdose: myasthenia gravis, dyspeptic disorders. There is no specific antidote, so symptomatic therapy is indicated.

Elkar is available in the form of a solution for oral administration in bottles of 25, 50 and 100 ml with a dosing device.

Is it necessary to operate on a patent foramen ovale?

Faced with such a diagnosis as a through hole between the atria, many patients wonder: is it necessary to operate on an open foramen ovale? The need for surgical intervention is determined by the size of the gap, the presence of concomitant diseases, painful symptoms and other characteristics of the body.

Medicine states that up to two years of LLC is the norm. The patient must be observed by a cardiologist and undergo annual echocardiography and cardiac ultrasound. If, upon reaching adulthood, the window has not closed, then the patient is strictly registered with a cardiologist, who decides on the method of treating the defect. The doctor takes into account the development of complications: thrombus formation, pulmonary failure, paradoxical embolism, ischemic and cardioembolic stroke.

If the oval window is large, there is no valve (atrial septal defect) or there has been a stroke, then surgery is a direct indication.

Surgery

One of the most effective methods for eliminating PFO is surgical treatment. It is performed at any age, but only if there are the following indications:

• Severe hemodynamic disturbances.
• High risk complications.
• Severe pain symptoms.
• The defect diameter is more than 9 mm.
• Rejection of blood into the left atrium.
• Limited physical activity caused by pathology.
• Contraindications to taking medications.
• Complications from the cardiovascular and respiratory systems.

The main goal of surgical intervention is to close the defect with a patch. The procedure is performed through the femoral or radial artery using a special endoscope and injecting contrast.

Surgical treatment is contraindicated for pathological changes in lung tissue and left ventricular failure. As a rule, the operation is performed upon reaching 2-5 years of age, when the window should physiologically close, but this does not happen. Each case is individual and requires a comprehensive comprehensive diagnosis to evaluate all possible risks operations.

Surgery for open oval window

The only and most effective method of treating the residual element of the fetal heart in adult patients is surgery. If the oval window is open, the following surgical interventions may be prescribed:

1. Open heart surgery.

Through an incision in the chest, the surgeon disconnects the heart from the blood vessels. The functions of the heart are taken over by a special device that pumps blood throughout the body and enriches it with oxygen. Using coronary suction, the doctor clears the organ of blood and makes an incision in the right atrium to eliminate the defect. The method has the following indications:

• Hole with a diameter of more than 10 mm.
• Severe circulatory disorders.
• Exercise intolerance.
• Frequent colds and inflammatory diseases.
• Pulmonary hypertension.

The following methods are most often used to close the gap:

• Suture application - the hole in the interatrial septum is sutured. The same manipulations are carried out for secondary defects located in the upper part of the septum.
• Applying a patch made of synthetic fabric, pericardium (a flap of the outer membrane of the heart) or a special patch. This method used for primary heart defects located closer to the ventricles, in the lower part of the septum.

After the operation, the doctor stitches the incision and connects the heart to its blood vessels. The incision in the chest is closed with a suture.

The advantages of such an operation are high accuracy of execution and rapid restoration of impaired blood circulation in the lungs and throughout the body, as well as the ability to eliminate defects of any size and location. The disadvantages of the method include: the need to connect a machine for artificial blood circulation, trauma due to the large incision of the chest, long recovery period– about 2 months and rehabilitation up to 6 months.

1. Endovascular surgery (closing the defect using a catheter).

These are less traumatic operations that do not require opening the chest. Indications:

• A window less than 4 mm in the central part of the interatrial septum.
• Return of blood from the left atrium to the right.
• Increased fatigue.
• Shortness of breath during physical activity.

During the operation, the doctor inserts a catheter into holes in large vessels in the groin or neck area. The endoscope is advanced into the right atrium. At the end of the device there is a special device for closing the window:

• Button devices - discs are installed on both sides of the interatrial septum, which are connected to each other using a nylon loop.
• An occluder is a special device that resembles an umbrella. It is introduced and opened in the left atrium, blocking the flow of blood from it.

The advantages of such minimally invasive treatment are: low risk of complications, the possibility of performing under local anesthesia, significant improvement in condition immediately after surgery, short recovery period - about a month. The main disadvantage of endovascular surgery is that it is not effective for large defects and narrowing of blood vessels. The operation is not performed with a window in the lower part of the septum or at the mouth of the vena cava/pulmonary veins.

Regardless of the surgical procedure chosen, most patients make a full recovery after surgery. There is also an increase in life expectancy by 20-30 years.

Indications for the occluder

If drug therapy is unable to eliminate the pathological symptoms or complications of MARS syndrome, then surgical intervention is indicated. Many patients are prescribed endovascular surgery, that is, the insertion of a special device, most often an occluder, into the heart through a vein or large artery.

Main indications for the occluder:

• LLC of small sizes.
• Localization of the defect in the central part of the interatrial septum.
• Increased fatigue and other symptoms of pathology.

With a minor cardiac anomaly, blood from the left atrium enters the right, and then into the right ventricle and pulmonary artery. This leads to stretching and overload of these parts of the heart. Normally, the left and right parts of the organ are separated from each other by a thin wall, which prevents the reflux of blood. That is, the main indication for the use of an occluder is precisely the enlargement and overload of the right parts of the heart.

An occluder is an umbrella or a miniature mesh. Using a catheter, it is inserted into the femoral vein and placed at the entrance to the left atrium. Implantation is carried out using an X-ray system, which visualizes the entire operation process.

The occluder is made from a biologically inert material that does not cause rejection reactions and takes root well in the body. Six months after the operation, the device is endothelialized, that is, covered with heart cells. In rare cases, after treatment, patients experience complications such as shortness of breath and chest pain.

Prevention

There are no special methods that would prevent incomplete fusion of the cardiac septum. Prevention of a patent oval window is based on healthy way life and following these recommendations:

• Refuse bad habits(smoking, alcoholism, drug addiction).
• Adhere to a rational and balanced diet that will provide the body with a complex of essential vitamins and minerals.
• Timely treatment of any diseases.

Women who are planning to have a child and are already pregnant should pay special attention to the prevention of anomalies:

• Avoid infectious diseases. Rubella is especially dangerous, as it provokes LLC and other congenital defects.
• Avoid contact with ionizing radiation, for example, X-ray machines, fluorographs.
• Do not contact with chemicals and their vapors (paints, varnishes).
• Take any medications only as prescribed by a doctor.

Forecast

With timely treatment, compliance with all medical recommendations and observation by a cardiologist, the prognosis for an open foramen ovale is quite favorable. The outcome of the anomaly depends on what therapy was prescribed and how effective it is.

Another important prognostic factor is functional state heart muscle. If there was an operation and it was successful, then there is a high chance of avoiding consequences and complications. This improves the prognosis of the defect. For example, endovascular occlusion of the LLC allows you to return to normal life within a short period of time, without any restrictions.

Without timely diagnosis, drug or surgical treatment, the prognosis of a minor cardiac anomaly is negative. The risk of serious complications exists with large window sizes, the development of paradoxical embolism and the presence of concomitant diseases.

Dispensary observation of children

Abnormal valve communication between the atria requires not only timely treatment, but also medical supervision. Clinical observation of children with a patent oval window involves systematic medical examinations and research (ultrasound, echocardiography). This allows us to assess the dynamics of the disorder and the risk of its complications.

Parents also receive special recommendations. The newborn is shown a protective regimen with long walks in the fresh air and good nutrition. This is necessary to harden the body and increase immune defense. Physiotherapy and therapeutic exercises are also recommended.

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What professions are contraindicated with a patent foramen ovale?

Such a physiological feature as incomplete fusion of the septum of the heart leaves an imprint not only on the lifestyle, but also on the field of activity.

Let's consider which professions are contraindicated when the oval window is open: pilot, diver, diver, scuba diver, driver, machinist, astronaut, caisson worker, army employee or submarine crew member. The above specialties can be dangerous for patients.

For example, when ascending or diving, blood clots can form, blocking blood vessels and causing death. And caisson work is dangerous because the patient has to breathe compressed air, which also negatively affects the cardiovascular system.

Open oval window and sports

Patients with a congenital through hole between the atria have many restrictions that are aimed at minimizing the risk of developing complications of the disease.

An open oval window and sports are acceptable if the defect does not cause abnormal blood flow, blue discoloration of the nasolabial triangle due to physical activity, embolism and other complications. When choosing a sporting hobby, the size of the window, as well as the results of the treatment, are taken into account.

Patent foramen ovale and army

According to the order of the Ministry of Defense of Ukraine dated August 14, 2008 No. 402, an open oval window and the army are incompatible. Patients with this anomaly are partially or completely exempt from military service.

• Limited fitness - the disease occurs with bleeding, the conscript is unfit for service in peacetime.

According to statistical data, the prevalence of patent foramen ovale (PFO) in the heart differs in different age categories. For example, in children under one year of age this is considered a normal variant, since according to ultrasound, an oval hole is detected in 40% of infants. In adults, this anomaly occurs in 3.65% of the population. However, in people with multiple heart defects, a gaping oval window is recorded in 8.9% of cases.

What is the “oval window” in the heart?

The oval window is an opening with a valve flap located in the septum between the right and left atria. The most important difference between this anomaly and a defect in the interatrial septum (ASD) is that the oval window is equipped with a valve and is localized directly in the area of ​​the oval fossa of the heart, while with ASD, part of the septum is missing.

Blood circulation in the fetus and the role of the oval window

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

But first things first:

• So, oxygenated blood enters the fetal body through the umbilical veins, one of which flows into the liver, and the other into the inferior vena cava through the so-called ductus venosus. Simply put, pure arterial blood reaches only the fetal liver, because in the prenatal period it performs an important hematopoietic function (it is for this reason that the liver occupies most of the abdominal cavity in the baby).
• The two streams of mixed blood from the upper and lower torso then flow into the right atrium, where, thanks to the functioning foramen ovale, the bulk of the blood flows into the left atrium.

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

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

During the first year of life, as a rule, the valve completely independently fuses with the walls of the hole. However, this does not mean at all that an unclosed foramen ovale after 1 year of a child’s life is considered a pathology. It has been established that the communication between the atria can close later. There are often cases where this process is completed only by the age of 5 years.

Video: anatomy of the oval window in the heart of the fetus and newborn

The oval window does not close on its own, what are the reasons?

The main cause of this pathology is a genetic factor. It has been proven that patent valve disease persists in people with a predisposition to connective tissue dysplasia, which is inherited. It is for this reason that in this category of patients one can find other signs of decreased strength and formation of collagen in the connective tissue (pathological joint mobility, decreased skin elasticity, prolapse (“sagging”) of the heart valves).

However, other factors also influence non-closure of the oval window:

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

Types of oval window according to the degree of nonfusion

• If the size of the hole does not exceed 5-7 mm, then usually in such a situation the detection of an oval window is a finding during echocardiography. It is traditionally believed that the valve valve protects against backflow of blood. That is why this option is hemodynamically insignificant and appears only during high physical activity.
• Sometimes there are cases when the oval window is so large (exceeds 7-10 mm) that the size of the valve is not enough to cover this hole. In such situations, it is customary to talk about a “gaping” oval window, which clinical signs may be practically no different from ASD. Therefore, in these situations the border is very arbitrary. However, if we look at it from an anatomical point of view, then with an ASD there is no valve flap.

How does the disease manifest?

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

For children infancy with an open oval window it is characteristic:

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

1. Paleness of the skin;
2. Increased heart rate in infants.

Adults with pathology may also experience bluish lips with:

1. Physical activity, which is fraught with an increase in pressure in the pulmonary vessels ( long delay breathing, swimming, diving);
2. Heavy physical work (weightlifting, acrobatic gymnastics);
3. For lung diseases (bronchial asthma, cystic fibrosis, emphysema, pulmonary atelectasis, pneumonia, with hacking cough);
4. In the presence of other heart defects.

With a pronounced oval hole (more than 7-10 mm), the external manifestations of the disease are as follows:

• Frequent fainting;
• The appearance of bluish skin even with moderate physical activity;
• Weakness;
• Dizziness;
• Child's delay in physical development.

Diagnostic methods

Echocardiography is the “gold” standard and the most informative method for diagnosing this pathology. The following signs are usually detected:

1. Unlike ASD, when the foramen ovale is open, it is not the absence of part of the septum that is revealed, but only its wedge-shaped thinning is visible.
2. Thanks to color Doppler ultrasound, you can see “swirls” of blood flow in the oval window area, as well as a slight discharge of blood from the right atrium to the left.
3. With a small size of the foramen ovale, there are no signs of enlargement of the atrium wall, as is typical for ASD.

The most informative is an ultrasound examination of the heart, performed not through the chest, but the so-called transesophageal echocardiography. At this study An ultrasound probe is inserted into the esophagus, as a result of which all the structures of the heart are visible much better. This is explained by the anatomical proximity of the esophagus and the heart muscle. The use of this method is especially relevant for obese patients, when visualization of anatomical structures is difficult.

In addition to cardiac ultrasound, other diagnostic methods can be used:

• An electrocardiogram may show signs of bundle branch block, as well as conduction disturbances in the atria.
• With a large foramen ovale, changes in the chest x-ray are possible (slight enlargement of the atria).

How dangerous is the pathology?

1. People at risk should avoid heavy physical activity, as well as choosing professions such as scuba diver, diver, and diver. It has been proven that in the presence of this pathology, the likelihood of developing decompression sickness 5 times than among the healthy population.
2. In addition, this category of people may develop a phenomenon such as paradoxical embolism. This phenomenon is possible in people with a tendency to form blood clots in the vessels of the lower extremities. A thrombus that breaks away from the wall of a vessel can enter the systemic circulation through the foramen ovale. As a result, blockage of blood vessels in the brain, heart, kidneys and other organs is possible. If the blood clot is large, it can cause death.
3. It is important to remember that people with a patent foramen ovale are more likely to develop a disease such as septic endocarditis. This is due to the fact that microthrombi can form on the walls of the valve flap.

Methods of treatment and prevention of complications

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

• Considering the likelihood of developing thromboembolism, patients at risk should also examine the veins of the lower extremities (with an assessment of the patency of the veins, the presence or absence of blood clots in the lumen of the vessels).
• When performing any surgical interventions in patients with an open foramen ovale, it is necessary to prevent thromboembolism, namely: elastic bandaging of the lower extremities (wearing compression stockings), as well as taking anticoagulants several hours before surgery. (You need to know about the presence of a defect and warn your doctor).
• It is important to observe a work and rest schedule, as well as dose physical activity.
• Sanatorium treatment (electrophoresis with magnesium sulfate has a positive effect).

In the presence of blood clots in the lower extremities, these patients require constant monitoring of the blood coagulation system (indicators such as international normalized ratio, activated partial thrombin time, prothrombin index are especially important). Also in such a situation, observation by a hematologist and phlebologist is mandatory.

Sometimes patients with a patent foramen ovale show signs of cardiac conduction disturbances according to ECG data, as well as unstable blood pressure. In such situations, you can take drugs that improve metabolic processes in cardiac muscle tissue:

1. Medicines containing magnesium (“Magne-B6”, “Magnerot”);
2. Drugs that improve the conductivity of nerve impulses (Panangin, Carnitine, B vitamins);
3. Drugs that activate bioenergetic processes in the heart (“Coenzyme”).

Surgery

Surgery may be required if the oval window has a large diameter with blood flowing into the left atrium.

Currently, endovascular surgery has become widespread.

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

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

Disease prognosis

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

Pregnancy and childbirth in women with the defect

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

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

All these factors contribute to the fact that the heart begins to beat faster, and the pressure in the pulmonary artery increases. Because of this, women with this heart abnormality may experience adverse complications. Therefore, pregnant women with this pathology are subject to observation by a cardiologist.

Are young people with a patent foramen ovale accepted into the army?

Despite the fact that in most cases this cardiac anomaly occurs without any clinical symptoms, young people with a patent foramen ovale are classified as category B with a restriction of suitability for military service. This is primarily due to the fact that with high physical activity there is a high probability of developing complications.

conclusions

Due to the development of additional research methods, the identification of such anomalies as a patent oval window has increased significantly.

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

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

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

A disease with the beautiful name “patent foramen ovale” in newborns and children under 5 years of age has recently become widespread. This “window” is an oval hole, up to 3 mm in diameter, located in the middle zone of the septal space between the two atria. The septum divides the two atria in half, representing a natural protection; in its center there is a small depression in the shape of an oval fossa. This “window” is located at the bottom of the recess, supplemented with a valve and can normally close after a certain period. But this does not always happen, so we will consider the open oval window and the method of its treatment in more detail.

In what cases is this normal?

An open foramen ovale in a child’s heart is a normal physiological sign when it heals on its own within 2-5 years. This window is required by the fetus because through it the atria are able to work and connect with each other. With the help of a deepening, blood from the vena cava instantly passes into the systemic circulation, since the fetal lungs do not yet work at full capacity during pregnancy. All children are born with this pathology, and it is always present in infants.

Sometimes the depression closes on its own in a child who has not yet been born, which provokes right ventricular failure and sudden death of the fetus in the womb or after birth. After birth, the baby breathes fully, and the blood circulation of the lungs begins to work. As oxygen flows 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! Because kids experience heavy loads, and, taking into account their unprepared body, the oval recess still works: during feeding, if the child cries or screams, the pressure in the right zone of the heart becomes higher.

When venous blood is released through the cavity, the baby’s triangular area under the nose turns blue, this symptom guarantees a functioning oval window. It should close completely by the age of five; the duration of the process depends on the characteristics of the body and manifests itself differently in each child. Usually, the closure of the oval does not occur immediately; ideally, the valve grows to the edges of the recess gradually. In certain cases, it closes after a short period of time; in others, the process can last several years.

Symptoms of pathology

An oval window in a newborn is considered normal and most often does not become a cause for concern. But in approximately 20-30% of people, such a hole in the atrium zone does not completely grow together and can remain half-open throughout life. In rare cases, it remains open: the deviation is recognized by ultrasound of the heart and is an atrial septal defect (ASD). Why is the defect dangerous? Will the child have health problems in the future?

Important! A person with an unclosed foramen ovale needs to consult a cardiologist more often; he will be able to quickly identify all abnormalities and prescribe treatment that will prevent complications from occurring.

With septal problems, the working valve typical of a patent oval window is completely absent. But the presence of a hole is not considered a dangerous deviation; it is classified as a small anomaly (MARS). If it has not closed in a child under three years of age, he is included in the second health group. Young people of conscription age with this defect are suitable for military service, but with additional restrictions. Such a depression does not cause problems in life, since it can function when coughing or during physical activity. Difficulties arise:

• when blood passes through the atria, if the oval window in the heart in adults is not completely covered;
• if you have diseases of the lungs or veins in the legs;
• with mixed type heart disease;
• during pregnancy and during childbirth.

Main factors

The reasons that there is an open oval window of 2 mm or larger in the heart are different, they are influenced by the physiological characteristics of the body of each individual person. On this moment there are no proven scientific theories or assumptions that could fully substantiate and confirm specific reasons pathology. When the valve does not fuse with the edges of the oval window, the cause is various factors. 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 is provoked by poor ecology and stressful conditions, smoking or taking alcoholic drinks mother during pregnancy or constant contact with toxic components. An open foramen ovale in the heart remains in an adult if developmental abnormalities, slow growth or prematurity are detected in childhood.

Important! In the presence of thrombophlebitis of the legs or pelvic area, some people have increased pressure in the area of ​​the right heart, which subsequently causes the appearance of an open small oval window in adults.

Hereditary causes, dysplasia of connective tissue, defects of the heart or congenital valves can lead to the opening of windows in children at an older age during development. If a child plays sports, he is at risk of developing such a defect, since playing sports seriously affects 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 occurs in the interatrial septum, and the presence of a defect is often discovered by chance, for example: during echocardiography and other diagnostic procedures. The pathology does not threaten serious complications, with the exception of other complex diseases that may affect it. For example: if a child or adult has hemodynamic problems when heart defects are detected, including a mitral or tricuspid valve or ductus arteriosus.

Symptoms of a defect such as a patent oval window appear in both infants and adolescents, and in specific cases vary depending on age. When it comes to a child 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 sign - blue discoloration of the nasolabial triangular area and lip area during exercise. Other deviations include:

• frequent diseases of the lungs and bronchi;
• noticeable delay in growth and development;
• shortness of breath and excessive fatigue during exercise;
• constant and causeless fainting and dizziness;
• heart murmurs heard during an appointment with a cardiologist.

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

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

Diagnostic methods

Before you appoint complex therapy and 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 the examination of the baby: in case of pathology, the doctor records systolic type noises. 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 undergo a full examination. Visualization using echocardiography is the main technique; it is prescribed to every child who reaches one month old, as evidenced by 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.

Treatment measures

The method of treatment for a child or adult depends on age, the presence of additional pathologies and 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’s health does not worsen, you just need to be examined by a pediatrician, therapist and cardiologist. Doctors will be able to assess the condition of the oval depression and take appropriate measures in time and prescribe treatment. If the window does not close naturally before the age of five, corrective medications are prescribed.

Important! When it comes to an oval-type window, the normal size of which does not exceed 5 mm, surgical correction is not required. If there is a large depression, specialists may prescribe surgery together with corrective therapy.

Patients at risk are those who do not have pronounced signs, but ischemia, heart attack, stroke, pathologies of the veins in the legs or other diseases are likely to occur. In some cases, surgery may be required when the oval window is too large in diameter and blood flows into the left atrium. Among the techniques, endovascular type surgery stands out: during the operation, a catheter is inserted into the patient’s thigh vein, which is then passed to the area of ​​the right atrium.

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

Preventing complications

The occurrence of complications can cause dangerous conditions, including the risk of thromboembolism; such patients need to study the condition of the veins in the lower extremities more often. Adults with a patent foramen ovale usually receive thromboembolic prophylaxis if surgery is to be performed. Such measures include taking anticoagulants or bandaging the legs, and a number of additional techniques. Often with this problem, symptoms of cardiac conduction problems and blood pressure disorders may occur.

Special preparations to improve metabolic processes strengthen the tissues and muscles of the organ during treatment. The list of drugs includes medications with the addition of magnesium, drugs that can improve the conductivity of the heart impulse, and drugs that can activate bioenergetic processes. General instructions for patients with a patent foramen ovale include reducing physical activity, maintaining a daily routine, and treatment in sanatoriums.

Open foramen ovale in a newborn: what is it?

The oval window in the heart is a hole developed in utero, 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 it, part of the oxygenated placental blood can flow from the right atrium to the left, bypassing the non-functioning lungs of the unborn baby. This ensures normal blood supply to the head, neck, brain and spinal cord.

During the first breath, the child’s lungs and pulmonary circulation begin to function, and the need for communication between the right and left atria loses its relevance. When the baby inhales and first cries, 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 completely disappears. But it happens that the oval window remains open. What threatens this 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 a patent foramen ovale after 1-2 years is considered a minor anomaly of cardiac development (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. This prevalence of this anomaly has become an urgent problem for cardiology and requires monitoring.

Causes

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

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

Symptoms

A child with a patent foramen ovale is restless and does not gain weight well.

Normally, the size of the oval window in a newborn does not exceed the size of a pinhead and is securely covered with a valve that prevents the discharge of blood from the pulmonary circulation to the large one. With an open oval window measuring 4.5-19 mm or incomplete closure of the valve, the child may experience transient cerebrovascular accidents, signs of hypoxemia and the development of such severe complications, How ischemic stroke, renal infarction, paradoxical embolism and myocardial infarction.

More often, a patent foramen ovale 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 be:

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

During the examination, while listening to heart sounds, the doctor may register the presence of “murmurs.”

Possible complications

In extremely rare cases, a patent foramen ovale may be complicated by the development of paradoxical embolism. Emboli can become small gas bubbles, blood clots, or small fragments of fatty tissue. When the foramen ovale is open, they can enter the left atrium, then into the left ventricle. With the blood flow, the embolus can enter the vessels of the brain and cause the development of a cerebral infarction or stroke: conditions that can be fatal. This complication appears suddenly and can be caused by trauma or prolonged bed rest during periods of serious illness.

Diagnostics

To confirm the diagnosis of “patent foramen ovale,” the child must be examined by a cardiologist who can evaluate the results of cardiac ultrasound and ECG. In newborns and young children, transthoracic Doppler echocardiography is performed, which allows one to obtain a two-dimensional image of the interatrial wall and the movement of the valves over time, to assess the size of the oval window or to exclude the presence of a defect in the septum.

After confirmation of this diagnosis and in case of exclusion of other heart pathologies, the child is recommended to undergo clinical observation with mandatory repeated ultrasound of the heart once a year to assess the dynamics of the heart anomaly.

Treatment

In the absence of significant hemodynamic disturbances and symptoms, a patent foramen ovale in a newborn can be considered a normal variant and requires only constant monitoring by a cardiologist. Parents are advised to walk with their child in the fresh air more often, perform exercise therapy and hardening procedures, and follow the rules of a balanced diet and daily routine.

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, the prevention of paradoxical embolism. They may be prescribed vitamin-mineral complexes, drugs for additional nutrition of the myocardium (Panangin, Magne B6, Elcar, Ubiquinone) and antiplatelet agents (Warfarin).

The need to eliminate a patent 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, surgical treatment is not required.

In case of severe hemodynamic impairment, a low-traumatic operation for endovascular transcatheter closure of the hole with a special occluder may be recommended. This surgical intervention is performed under radiographic and endoscopic equipment. To the right atrium through femoral artery a special probe with a “patch”-plaster is inserted. This “patch” blocks the lumen 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 this, the patient can return to his normal lifestyle without any restrictions.

Patent foramen ovale (PFO) is a gap in the wall formed between the right and left atria. Normally, such an open gap functions during embryonic development and completely closes during the first year of the child’s life. If this does not happen, we begin to talk about an anomaly, which is assigned code Q21.1 in ICD 10.

On the left atrium side, the opening is covered by a small valve, which is fully matured by the time of birth. When the baby's first cry occurs and the lungs open, there is a significant increase in pressure in the left atrium, under the influence of which the valve completely closes the oval window. Over time, the valve firmly adheres to the wall of the interatrial septum, so the gap between the atria closes.

Most often, in half of children, such valve growth occurs during the first year of life. This is the norm. But if the valve size is insufficient, the gap may not close completely, that is, some hole will remain, the dimensions of which are determined in millimeters. Because of this, the atria are not isolated from each other. Then, which is otherwise called MARS syndrome.

Cardiologists classify it as.

In some cases, when there are no severe symptoms that affect the quality of life, this syndrome may be perceived as an individual feature of the cardiac structure.

But it often happens that such an anomaly becomes known by chance. For an adult, this may come as a surprise. They get scared, thinking that this is a serious vice and their life will soon end. Some young people believe that because of this they will not be allowed into the army. Are there reasons for such concerns? To understand this, you need to understand the causes, symptoms and other factors associated with LLC.

Causes

So, a patent foramen ovale is an opening, measured in millimeters, that forms between the atria. Through it, blood can flow from one atrium to another. Most often it comes from the left atrium to the right. This is due to the fact that the pressure in the cavity of the left atrium is higher. When a diagnosis is made, the following formulation is often given: LLC with left-right reset.

But LLC is not, although in accordance with ICD 10 they are assigned the same code. A defect is a more serious pathology. MARS syndrome is not a congenital heart defect or a septal defect. And the differences are not only in the structure and development of the heart, but also in the causes, symptoms, treatment and other factors.

The reasons for this condition of the oval window are not always precisely known. It is believed that a hereditary predisposition can lead to this condition. Of course, it’s unlikely that anything can be done about this factor. But there are other reasons that largely depend on the woman who carries new life, their presence becomes especially important during the period of carrying a child in the womb:

• smoking;
• malnutrition;
• toxic poisoning with drugs;
• alcoholism and drug addiction;
• stress.

Unfortunately, today more and more women are starting to lead a bad lifestyle and continue to do so even during pregnancy. At the same time, they do not think at all that their baby will suffer. A patent foramen ovale is just one consequence, which can be considered not very serious compared to others, which can be, for example, a heart defect.

A patent oval window may develop due to poor environmental conditions.

LLC can develop for other reasons: poor environmental conditions, connective dysplasia, prematurity of the child. If these reasons occur at a time when, you need to be prepared for the consequences that relate to the development of the baby or the organs of his body.

It has been noted that MARS syndrome often occurs with other cardiac malformations. These include open aortic disease, as well as congenital defects of the mitral and tricuspid valves.

Several other factors can contribute to window opening:

• very strong physical activity, which is especially true for athletes who engage in weightlifting, diving, and strength sports;
• manifestations of pulmonary embolism in those patients who have thrombophlebitis of the lower extremities and pelvis.

Symptoms

Although the abnormality is often detected in adults during testing for other conditions, it is best to do this early because other heart problems may be detected. Thanks to the identified symptoms, an adult or a child’s parents can seek help in time. medical care, undergo an examination, after which a diagnosis will be made: LLC with left-right reset, and a code will be noted in accordance with ICD 10.

If the size of the defect is small, from two to three mm, there is no particular reason to worry, since this is a common situation for a small child. Therefore, there are no special manifestations.

By the way, all children under one year of age are prescribed a heart ultrasound, which makes it possible to identify LLC. If the size of the defect is more than three mm, most likely, some signs will be observed that allow certain conclusions to be drawn:

• nasolabial triangle or lips in a child when he cries or screams a lot;
• frequent colds, bronchitis, pulmonary inflammation;
• slowdown in psychological or physical development, which may even indicate that the oval window is open even by two or three mm;
• attacks of loss of consciousness;
• fast fatiguability;
• feeling of lack of air.

The latter signs are observed when the size of the anomaly exceeds three mm. If the doctor suspects that a child has PFO, he will refer him for examination by an experienced cardiologist and an ultrasound scan. This way the dimensions of the defect are clarified and it turns out that they exceed three mm. All this allows you to understand whether there is cause for concern. By the way, the size of an open window can reach 19 mm.

Cyanosis of the nasolabial triangle may indicate a patent oval window measuring more than three mm

There are practically no specific symptoms in adults. A person may complain of severe pain in the head area. A preliminary diagnosis in accordance with ICD 10 can be made on the basis of almost the same signs that were listed above. There may also be impaired mobility of body parts and periodic numbness of the limbs.

It is important to understand that an open oval window is not a death sentence! The heart is still functioning well, of course, it all depends on what concomitant diseases, heart defects, and so on are present, but in itself PFO does not pose a very serious danger, although the consequences can be very unpleasant, but this will be discussed later. To diagnose PFO with left-right shunting and designate the code according to ICD 10, it is necessary to conduct an examination.

Diagnostics

First, the doctor collects general data about the patient’s health, anamnesis, and complaints. This will help identify the reasons possible complications. A physical examination is also performed, which means the doctor examines skin, determines body weight, measures blood pressure, listens to heart sounds.

Then appointed general analysis blood, urine, biochemical blood test. These tests help identify comorbidities, cholesterol levels, and other important factors.

In addition, the picture is clarified by such studies as coagulogram, ECG, echo CG, transesophageal, contrast echocardiography, chest x-ray.

All this allows you to accurately assess the patient’s health status, his heart, determine the size of the anomaly in millimeters, and so on.

Thanks to such important studies, the doctor puts accurate diagnosis, defines the code in accordance with ICD 10. What treatment is prescribed if a patent foramen ovale with left-right collection or another similar diagnosis is detected?

Treatment

What to do if you suspect problems with the oval cardiac window? Go to the doctor immediately! This rule applies to everyone who discovers at least some health problems. What to do after visiting a doctor? Follow his recommendations and appointments.

The scope of treatment measures is determined depending on the symptoms and concomitant diseases. Although the ICD 10 abnormality code is atrial septal defect, patent foramen ovale with left-to-right shunt is a different condition.

If there are no obvious disturbances in cardiac function, the doctor gives the patient recommendations that are aimed at properly organizing the daily routine, limiting physical activity, and observing nutritional rules. Taking medications for asymptomatic anomalies is not advisable. General strengthening procedures may be prescribed, such as exercise therapy, treatment in sanatoriums and others.

For minor complaints about the functioning of the heart and blood vessels, vitamins and means to strengthen the heart muscles may be prescribed.

If there are minor complaints about the functioning of the heart and blood vessels, treatment based on taking vitamins and drugs that strengthen the heart muscle can be prescribed. At the same time, it is important for the patient to limit himself in terms of physical activity. If, in a PFO with a left-to-right shunt and a significant size of the anomaly in millimeters, the symptoms are clearly expressed and there is a risk of blood clots, the following may be prescribed:

• disaggregants, anticoagulants, these drugs prevent the formation of blood clots;
• endovascular treatment, when a patch is applied through a catheter to the oval window, stimulating the opening to close with connective tissue; this patch resolves on its own after a month.

Antibiotics are prescribed after surgery to prevent possible development infective endocarditis. Thanks to endovascular treatment, a person returns to a full life, in which there are practically no restrictions.

Under no circumstances should you prescribe medications yourself. Each remedy has contraindications, side effects. For these and other reasons, every prescription should be made by a physician. When a diagnosis is made: a patent foramen ovale in the heart, in accordance with ICD 10, it is important for the patient to know what complications there may be.

Complications and prevention

Of course, the likelihood and form of complications depends on many factors. But it is important to understand that complications are rare. In fact, the following diseases can develop:

• renal infarction;
• stroke;

If an open foramen ovale is detected, it is necessary to regularly see a cardiologist and perform an ultrasound of the heart.

This occurs because a paradoxical embolism develops. If we talk about forecasts, then in most cases everything is favorable. Those who have been diagnosed with LLC in accordance with ICD 10 need to be regularly monitored by a cardiologist and undergo an ultrasound of the heart. It is necessary to abandon sports that constantly subject the body to very strong physical stress.

It is important for every woman who is planning to have a baby or has already become pregnant to remember that she can prevent her unborn child from developing a heart abnormality. You cannot smoke, drink, take drugs or do anything that could somehow affect the health of the fetus in the womb.

As a result, we can say that LLC is an anomaly, which in itself does not pose a very serious danger, unless we are talking about the fact that there is an accompanying defect or other serious defect. It all depends on various factors. But the health of every person is very often in his hands! Every day you need to think about your health and your loved ones!