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

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

An open oval window is not such a terrible diagnosis for a child and his parents.

What is it

This is the name of 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 in a fetus, the heart functions somewhat differently than in a baby or an adult.

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

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

The window between the atria can close even by age 5

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

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

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

Causes

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

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

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

In the next video, you can see how the blood circulation and activity of the baby's heart 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 rather poor. You can suspect LLC in a baby by:

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

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

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

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

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

Diagnostics

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

Ultrasound signs of an open oval window are:

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

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

Komarovsky's opinion

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

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

Treatment

If there is no pronounced clinic and there are no problems with the work of the heart, which is especially often the case with the presence of LLC, no medication is required. The child is recommended measures that are important for the general strengthening of the body:

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

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

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

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

Forecast

Many parents worry that the "hole in the heart," as they call the LLC, will threaten the child's life. In fact, such a 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 examine the baby with a cardiologist every 6 months with an ultrasound examination.

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

Many children with LLC feel quite healthy

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

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

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

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

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

However, there are many conditions that do not require immediate therapy or surgery to be identified. It is worth remembering for young parents who fall into some kind of panic when they are told that there is a small hole in the place of a fetal message in the heart of a newborn baby.

Often when explaining the diagnosis, this is the name of an open oval window.

Anatomical background

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

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

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

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

Is it a pathology?

With the birth of a baby and the first cry (inhalation), the lungs expand, the pressure gradient between the chambers of the heart changes, and the embryonic window slams shut. In the future, connective tissue grows in this place, only the fossa remains.

There are many situations where the closing process is delayed. The hole remains open up to 2 years in 50% of babies, 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 a similar anomaly in the heart.

Based on various studies, doctors agreed that the fundamental criterion for alertness in the presence of a message 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 opening itself.

When not to worry?

If the hole in the newborn in the area of ​​the oval window has a diameter of up to 7 mm, there are no manifestations of violations, then they do not resort to intervention on the heart. The kid is observed at the prescribed time. After a certain amount of time, a repeated Echo-KG is carried out to assess the dynamics of the size of the open window.

If the hole has not closed in the first months and has borderline dimensions (5-6 mm), the doctor may prescribe drugs that improve metabolism in the heart, vitamins and general strengthening procedures. Such medication support, good organization of the daily routine and nutrition help speed up the process of overgrowing of a small message between the atria.

Possible Signs

An open oval window can manifest itself as cyanosis of the nasolabial triangle when feeding, crying a baby, straining during stool removal. The child does not gain enough weight, is capricious, does not suckle well.

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

Preventive measures

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

Genetic failures or impaired intrauterine ontogenesis can become a cause that interferes with the normal growth and functioning of the unborn child. That is why, while carrying a baby, mothers should think about correct diet nutrition, daily regimen, the use of vitamins and minerals, it is also important to follow the recommendations of the obstetrician-gynecologist.

Operative treatment

If the oval window has hemodynamically significant dimensions (with mixing of blood), there is no decrease in the lumen of the message 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). A synthetic implant is brought to the interatrial septum through a small puncture in the femoral vessel under hardware control with the help of a guidewire, which closes the active fetal message.

Forecast

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

An open oval hole, which is small, in older children is already considered as MARS (small anomaly of heart development), can limit excessive physical activity and extreme sports for them.

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The gap in the wall between the right and left atrium is the open oval window of the heart. 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 abnormalities.

Q20-Q28 Congenital malformations of the circulatory system.

Q21 Congenital malformations of the cardiac septum.

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

The heart is complex and has many important functions. The organ contracts rhythmically, providing blood flow through the vessels. It is located behind the sternum in the middle thoracic cavity and is surrounded by the lungs. Normally, it can move to the side, as it hangs on the blood vessels and has an asymmetrical localization. Its base is turned towards the spine, and the apex is turned towards the fifth intercostal space.

Anatomical features of the heart muscle:

• The heart of an adult 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 pulmonary veins enter the left atrium, and the right hollow veins enter the right atrium. The pulmonary artery emerges from the right ventricle, and the ascending aorta emerges from the left.
• The left ventricle and left atrium are the left section where arterial blood is located. The right ventricle and atrium are the venous heart, that is, the right section. The right and left parts are separated by a solid partition.
• The left and right chambers are separated by an interventricular and interatrial septum. Thanks to them, the blood from different departments hearts do not mix with each other.

Incomplete overgrowth of the septum is a congenital anomaly, that is, a residual element of embryonic development. In fact, this is a hole between the two atria through which, during contractions, blood is pumped from one ventricle to the other.

The atrial opening with a valve develops in utero and protrudes necessary condition normal work the cardiovascular system at this stage of development. It allows part of the placental and oxygenated blood to penetrate from one atrium to another without affecting undeveloped and non-working lungs. This ensures a normal blood supply to the fetus's 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. Due to this, the valve completely closes the embryonic cleft. Gradually, the valve grows tightly with the walls of the interatrial septum. That is, the gap between the right left atrium closes.

In about 50% of cases, valve accretion occurs in the first year of a baby's life, but in some cases by 3-5 years. When the valve is small, the slit does not close and the atria are not isolated. This pathology is classified as MARS syndrome, that is, a minor anomaly in the development of the heart. 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 foramen ovale (PFO) in the heart has a prevalence in two age categories:

• In children under one year old, this is the norm. When conducting 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 infection of the septum is detected even in infancy. In 30% of adults, this disorder manifests itself as a channel or shunt, which provokes various diseases on the part of the cardiovascular system. In healthy and full-term babies, the hole is overgrown by 50% in the first year of life.

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Reasons for an open oval window

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

• The birth of a premature baby.
• Bad habits of the mother during gestation (alcohol, drug addiction, smoking).
• Congenital malformations of the heart muscle.
• Toxic drug poisoning during pregnancy.
• CNS disorders: severe stress and nervous experiences, emotional exhaustion.
• Connective tissue dysplasia.
• Unfavorable ecology.
• Malnutrition 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 a pathological condition are most often associated with genetic disorders on the first line of family ties.

The appearance of the disorder is facilitated by:

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

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

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Pathogenesis

The mechanism of development of the 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 abnormalities in the formation, that is, connective tissue dysplasia. Violation leads to involvement in pathological process heart valves, subvalvular apparatus and cardiac septum.

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

Hemodynamically insignificant open oval window

The movement of blood through the vessels is associated with the difference in hydrostatic pressure in different sites circulatory system. That is, the blood moves from a high pressure area to a low one. This phenomenon is called hemodynamics. An open gap in the wall between the right and left atrium is located at the bottom of the oval hollow on the inner left wall of the right atrium. The hole is small in size from 4.5 mm to 19 mm and is usually slotted.

Hemodynamically insignificant open oval window is an anomaly that does not cause blood supply disturbances and does not affect the patient's health. This is the case if the defect is small and has a valve that prevents the blood from shunting from left to right. In this case, people with pathologies are unaware of its presence and lead a normal life.

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Symptoms of an open oval window

In most cases, the symptoms of an open oval window do not appear in any way. 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, which can remain without proper attention for a long time:

• Cyanosis and increased pallor of the nasolabial triangle during physical exertion.
• Propensity to colds and bronchopulmonary pathologies of an inflammatory nature.
• Delayed 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 attention. If various neurological disorders are observed, then this may indicate complications of the disorder due to its long course.

First signs

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 such cases:

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

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

Open oval window 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, which are connected by special valves. An open oval window in an adult is a pathology that is most often diagnosed in newborns and premature babies.

In adulthood, the unsealed opening 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 unaware of the violation. Only when conducting an ultrasound is it possible to identify the problem.

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

• If the window opens 2-3 mm, but is not accompanied by deviations from the cardiovascular system, then this condition is not reflected in 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 exertion.
• 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.

The inferiority of the LLC, as a rule, 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 shown. The presence of clinically insignificant symptoms at first glance is also taken into account:

• Blue nasolabial triangle in inflammatory diseases and after physical exertion.
• Frequent fainting.
• Varicose veins and thrombophlebitis.
• Shortness of breath.
• Predisposition to colds.
• Tachycardia.
• Migraine.
• Increased volume of blood 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 exertion. The risk group includes: divers and divers, patients with PE (pulmonary embolism) and thrombophlebitis.

Treatment for a painful condition depends on its severity. Many adults are prescribed a complex of preventive methods. In especially severe cases, it is shown 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 pathology are distinguished by the degree of organ damage and the nature of the symptoms that arise in this case. V medical practice there is such a thing as MARS syndrome (small anomalies in the development of the heart), which includes this disorder. The group of pathologies includes disorders in the development of structures of external and internal structure heart muscle and adjacent vessels.

Incomplete infection 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.
  • Prolapsing comb muscles in the right atrium.
• Tricuspid valve - displacement of the septal leaflet into the cavity of the right ventricle, dilatation of the right AV opening, protrusion of the tricuspid valve.
• Pulmonary artery - prolapse of the valves of the pulmonary artery valve and dysplasia of its trunk.
• Aorta - borderline wide / narrow aortic root, bicuspid valve, sinus dilatation, asymmetry of the valve leaflets.
• The left ventricle is a small aneurysm, trabeculae, chords.
• Mitral valve.

1. Causes and conditions of occurrence.

• Connective tissue dysplasia.
• Vegetative dysfunctions.
• Ontogenesis.
• Violations of cardiogenesis.

1. Possible complications.

• Heart rhythm disorders.
• Pulmonary hypertension.
• Infective endocarditis.
• Disorders of cardiohemodynamics.
• Fibrosis and calcification of the 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 are identified, as well as their severity. In 95% of cases, hemodynamic disturbances and side symptoms do not occur. As we grow older, structural abnormalities disappear.

Forms

Normally, an open oval window is temporary, since it is necessary for oxygenation of the fetus during embryonic development. That is, the anomaly exists in all children, but by the time of birth it is overgrown, since there is no need for additional oxygen saturation, since the lungs begin to work.

The types of incomplete overgrowth of the septum depend on the size of the hole:

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

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

Open oval window with relief

In most cases, the 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 the discharge of blood from the right atrium to the left. As a rule, this is observed with a window size of no more than 5-7 mm.

An open oval window with a discharge indicates a large size of the 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 and continuing further movement can reach the vessels of the brain. This leads to the development of stroke, thrombosis and heart attacks. To prevent such violations, a comprehensive diagnosis and timely treatment should be carried out.

Open oval window with left-right discharge

The short channel between the right and left atrium, covered by a valve and with abnormal circulation, is an open oval window with a left-right discharge. Normally, fluid is discharged in one direction - from right to left. LLC is a physiological feature of the body, which is necessary during the period of embryonic development. But after birth, the need for it disappears and the gap is overgrown, as the lungs begin to work.

There are the following types of oval window functioning:

• No hemodynamic relief.
• With right-left discharge.
• With left-right discharge.
• With biderectorial shunting.

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

• Oval window flap perforation.
• Valve deficiency with dilated left atrium
• Valve failure.

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

Open oval window without signs of embolic activity

The 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 LLC closes after birth, but in 30% it remains open, causing various pathological symptoms.

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

An open oval window 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) pressure in the right atrium increases and a right-left shunt occurs, causing 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 face such problems:

• Heart rhythm disorders.
• Cerebral circulation disorder.
• Pulmonary hypertension.
• Paradoxical embolism.
• Fibrosis and calcification of the valve leaflets of the heart muscle.
• Violations of cardiohemodynamics.
• Heart attack.
• Stroke.
• Sudden death.

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

Is an open oval window dangerous?

Many experts consider the innate communication between the right and left atria to be normal. Whether an open oval window 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 ultrasound 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 by the development of embolism. This is a condition when blood clots, gas bubbles and bacterial microorganisms enter the arterial blood from the venous blood, and through the left heart into the arteries internal organs... In this case, they may be amazed coronary arteries, kidneys, spleen, limbs. Heart rhythm disturbances are dangerous for strokes and heart attacks.

Open oval window diagnostics

Small heart anomalies are characterized by a latent, that is, latent course. Pathology can be suspected if characteristic symptoms or during a routine examination of the body. Diagnostics of an open oval window is carried out by the following methods:

1. Taking 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 gestation, the degree of physical activity of the patient.
2. External examination - this method is ineffective, since LLC does not always make itself felt with pronounced symptoms. But the blue discoloration of the nasolabial triangle during crying and straining, pallor of the skin, poor appetite and physical retardation suggest 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 the level of homocysteine ​​and antithrombin.
• Determination of protein C and protein S.

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

During the diagnosis, the doctor evaluates nutrition, identifies eating disorders and symptoms of anomalies associated with an imbalance in consumed nutrients... The ecological characteristics of the patient's living environment are also taken into account.

Noise when the oval window is open

One of the methods for diagnosing the through hole between the atria is listening to the chest with a phonendoscope. During the work of the cardiovascular system, peculiar tones arise. The heart pumps blood, and valves regulate its direction.

• Before the heart contracts, the valves between the atria and the 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.
• A tone occurs when the valves are closed, if an obstruction forms in the heart and for many other factors.

The murmur when the oval window of the heart is open is not always possible to identify with the help of 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 be formed.

A murmur in the heart is: soft, rough, blowing. All noises are divided into the following groups:

• Pathological - often act as the first, and sometimes the only sign of anomalies of the cardiovascular system.
• Healthy - associated with the growth characteristics of the chambers and blood 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 ultrasound procedure... These methods make it possible to assess the structure of the heart and the surrounding vessels and tissues.

Instrumental diagnostics

Examination of the body using special equipment is instrumental diagnostics. If you suspect incomplete infection of the septum of the heart, the following studies are shown:

• Radiography - identifies possible heart problems caused by an increase in blood pressure in the right ventricle due to an atrial septal defect.
• Ultrasound of the heart - is performed to determine the boundaries of the LLC and its size. It is prescribed for newborns and older patients.
• Echocardiography - performed when various heart anomalies are suspected. Allows you to identify pathology even with its latent course. It is carried out in two states: after physical exertion and when 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.
• Trans food echocardiography - prescribed for suspected abnormalities in older children and adolescents. During the examination, an endoscope is immersed in the esophagus, bringing it as close as possible to the heart muscle. For more reliable results bubble contrasting can be assigned.
• Cardiac catheterization is one of the most accurate but aggressive diagnostic methods. Most often used before surgery. The procedure is the advancement of the probe along the arterial blood flow to the heart for its detailed visualization.

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

Open oval window on ultrasound

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

An open oval window on ultrasound is characterized by the following symptoms:

• Enlargement of the right heart 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 atrial septum.

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

Echographic 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.

Echographic signs of an open oval window can be detected immediately after birth with the help of such studies:

• Contrast echocardiography - detects OOO or atrial septal defect of the smallest size. For diagnosis, the patient is given an intravenous injection with saline. In the presence of a gap, the smallest 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 the functioning flap. This method is especially informative in newborns and early childhood patients.

In addition to the above methods, transesophageal echocardiography with bubble enhancement can be prescribed to determine the echographic signs of the disorder.

Dimensions of an open oval window

Small heart anomalies can be suspected using their characteristic symptomatology, which very often proceeds 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 atrium can be of the following dimensions:

• 2-3 mm is considered normal and does not cause any symptoms or complications.
• 5-7 mm is the small size of the anomaly. Under the action of certain factors, it causes a number of unpleasant symptoms that 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 a maximum size of more than 19 mm.

Studies have shown that in about 40% of adults, the opening between the atria is not tightly closed. The dimensions of the slit are on average 4.5 mm. If the window remains completely open, then a defect of the interatrial septum is diagnosed, which, unlike LLC, 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 a little less often in healthy children. An open oval window of 2, 3, 4, 5 mm is considered normal, but under the action of certain factors it can cause pathological symptoms.

Hole sizes of more than 5 mm flow with characteristic signs that make it possible to suspect a violation:

• Blue nasolabial triangle with physical activity, crying, screaming.
• Slowing down mental and physical development.
• Loss of consciousness and dizziness.
• Fast fatiguability.
• The 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 activities, the doctor will prescribe treatment and give recommendations for correcting the disease.

Differential diagnosis

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

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

• Atrial septal defect.
• Atrial septal aneurysm.
• Disorders of hemodynamic discharge.

Let us consider in more detail the differences in 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 an open oval window

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

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

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

1. In the absence of symptoms, therapy is not required. The patient is recommended to be monitored by a therapist / pediatrician and cardiologist, periodic assessment of the dynamics of the state 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 the patients are prescribed medications to thin the blood (Warfarin, Aspirin and others).
2. In the presence of pain symptoms, not only medication is indicated, but also surgery... With a pronounced discharge of blood from right to left and the risk of embolism, the defect is closed using an occlusive device or a special resorbable patch.

Elkar with an open oval window

One of the methods of treatment for MARS syndrome is drug therapy. Elkar with an open oval window of the heart is prescribed from the first days of the disease. Consider more detailed instructions of this drug and features of its application.

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

The active ingredient regulates the consumption of glycogen and increases its stores in the liver and muscle tissues. Possesses pronounced lipolytic and anabolic properties.

• Indications for use: improvement of the condition of premature babies and newborns after birth trauma, asphyxia. It is prescribed for a 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, for dermatological diseases. Accelerates the recovery of the body during intense physical and psycho-emotional stress, with reduced performance and increased fatigue.
• Method of application: the medicine is taken orally 30 minutes before meals. The dosage and course of treatment are individual for each patient, therefore, are determined by the attending physician.
• Side effects: recorded isolated cases of dyspeptic disorders, myasthenia gravis, gastralgia, systemic allergic reactions.
• Contraindications: hypersensitivity to the components of the drug. If the drug is prescribed for patients under 3 years of age, then careful medical supervision is required. It is not used for the treatment of pregnant women and during lactation.
• Overdose: myasthenia gravis, dyspeptic disorders. There is no specific antidote, therefore symptomatic therapy is indicated.

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

Do I need to operate on an open oval window?

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

Medicine claims that up to two years LLC is the norm. The patient must be observed by a cardiologist and annually undergo echocardiography, ultrasound of the heart. If, upon reaching an older age, the window has not closed, then the patient is placed on a strict record 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 a stroke has been suffered, then surgery is a direct indication.

Surgery

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

• Gross hemodynamic disturbances.
• High risk complications.
• Severe pain symptoms.
• The defect diameter is more than 9 mm.
• Injection 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 the 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 with the introduction of contrast.

Surgical treatment is contraindicated in case of pathological changes in the tissues of the lungs and in case of 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.

Operation with an open oval window

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

1. Open heart surgery.

Through an incision in the chest, the surgeon disconnects the heart from the vessels. The functions of the heart are taken over by a special apparatus that pumps blood throughout the body and enriches it with oxygen. With the help of coronary suction, the doctor cleans 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 greater than 10 mm.
• Severe circulatory disorders.
• Physical intolerance.
• Frequent colds and inflammatory diseases.
• Pulmonary hypertension.

To close the gap, the following methods are most often used:

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

After surgery, the doctor sutures 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 performance and rapid restoration of impaired blood circulation in the lung and the whole body, as well as the ability to eliminate defects of any size and localization. The disadvantages of the method include: the need to connect a heart-lung machine, trauma due to a large incision in the chest, long recovery period- about 2 months and rehabilitation up to 6 months.

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

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

• The window is less than 4 mm in the central part of the interatrial septum.
• Injection of blood from the left atrium to the right.
• Increased fatigue.
• Shortness of breath with physical activity.

During surgery, the doctor inserts a catheter into the holes in the large vessels in the groin or neck area. The endoscope is advanced into the right atrium. A special device for closing the window is fixed at the end of the apparatus:

• 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 under local anesthesia, a significant improvement in the condition immediately after the operation, a short recovery period - about a month. The main disadvantage of endovascular surgery is that it is not effective for large defects and vasoconstriction. The operation is not performed with a window in the lower part of the septum or at the orifices of the vena cava / pulmonary veins.

Regardless of the surgical intervention chosen, most patients recover completely after surgery. There is also an increase in life expectancy of 20-30 years.

Indications for occluder

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

The main indications for the occluder:

• LLC is small in size.
• 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 overloading of these parts of the heart. Normally, the left and right parts of the organ are separated by a thin wall, which prevents the flow of blood. That is, the main indication for the use of the occluder is precisely the increase and overload of the right heart.

The occluder is an umbrella or miniature mesh. With the help of a catheter, it is introduced 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 process of the operation.

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 endothelized, that is, it is covered with heart cells. In rare cases, after treatment, patients face complications such as shortness of breath and chest pain.

Prophylaxis

There are no special methods that would prevent incomplete infection of the heart septum. The prevention of an open oval window is based on healthy way life and compliance with such recommendations:

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

Particular attention should be paid to the prevention of anomalies by women planning to have a child and are already pregnant:

• 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 directed by a doctor.

Forecast

With timely treatment, implementation of all medical recommendations and observation by a cardiologist, the prognosis of an open oval window is quite favorable. The outcome of the anomaly depends on which therapy was prescribed and how effective it is.

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

Without timely diagnosis, medical or surgical treatment, the prognosis of a minor heart anomaly is negative. The risk of serious complications exists with the large size of the window, 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. Dispensary observation of children with an open oval window provides for systematic medical examinations and research (ultrasound, echocardiography). This makes it possible 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 for hardening the body and increasing immune defense... Physiotherapy and remedial gymnastics are also recommended.

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What professions are contraindicated when the oval window is open?

Such a physiological feature as incomplete infection of the septum of the heart leaves an imprint not only on the way of life, but also on the sphere of activity.

Consider what 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 climbing or diving, blood clots can form, blocking the 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 sport

Patients with a congenital through-hole between the atria have many limitations, which are aimed at minimizing the risk of developing complications of the disease.

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

Open oval window and army

According to the order of the Ministry of Defense of Ukraine dated 14.08.2008 No. 402, an open oval window and the army are incompatible. Patients with this anomaly are partially or completely exempt from military service.

• Limited suitability - the disease proceeds with the discharge of blood, the conscript is unfit for service in peacetime.

According to statistics, the prevalence of an open oval window (OOO) in the heart differs in different age categories. For example, in children under one year old, this is considered a variant of the norm, since according to ultrasound data, an oval hole is found 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 a flapped orifice 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 oval fossa region, while in ASD it is part of the septum that is missing.

Fetal blood circulation and the role of the oval window

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

But first things first:

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

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

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

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

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 non-closure of the valve flap persists in people with a predisposition to connective tissue dysplasia, which is inherited. It is for this reason that other signs of a decrease in strength and collagen formation in the connective tissue can be found in this category of patients (abnormal joint mobility, decreased skin elasticity, prolapse ("sagging") of the heart valves).

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

1. Unfavorable ecology;
2. Taking certain medications during pregnancy. Most often, this pathology is caused by non-steroidal anti-inflammatory drugs (NSAIDs). These drugs have been shown to 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, as well as smoking during pregnancy;
4. Premature birth (this pathology is more often diagnosed in premature babies).

Types of oval window according to the degree of non-closure

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

How does the disease manifest itself?

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

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

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

1. Pallor of the skin;
2. Rapid heartbeat in infants.

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

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

Diagnostic methods

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

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

The most informative is an ultrasound examination of the heart, carried out not through the chest, but the so-called transesophageal echocardiography. At this study an ultrasound probe is inserted into the esophagus, resulting in much better visibility of all structures of the heart. This is due to the anatomical proximity of the esophagus and heart muscle. The application of this method is especially important for obese patients, when visualization of anatomical structures is difficult.

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

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

What is the danger of pathology?

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

Methods of treatment and prevention of complications

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

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

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

Sometimes in patients with an open oval window, there are signs of cardiac conduction abnormalities according to ECG data, as well as unstable blood pressure. In such situations, you can take drugs that improve metabolic processes in the tissue of the heart muscles:

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

Surgery

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

At the moment, endovascular surgery has become widespread.

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

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

Disease prognosis

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

Pregnancy and childbirth in women with a defect

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

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

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

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

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

conclusions

In connection with the development of additional research methods, the identification of such an anomaly as an open oval window has increased significantly.

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

Particularly noteworthy is the presence of a large oval foramen, which in fact is an analogue of an atrial septal defect. In this situation, surgical correction is recommended for patients.

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

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

In what cases is this the norm

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

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

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

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

Symptoms of pathology

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

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

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

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

The main factors

The reasons for the presence of an open oval window of 2 mm or more in the heart are different, they are influenced by the physiological characteristics of the organism 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, various factors are the cause. A removed echocardiography or ultrasound of the heart can reveal the presence of LLC.

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

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

Hereditary causes, dysplasia lesions of connective tissues, defects of the heart or valves of a congenital nature can lead to the opening of windows in children at an older age during development. If a child plays sports, he is at risk of developing such a defect, as playing sports seriously affects his 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 often they learn about the presence of a defect by chance, for example: during echocardiography and other diagnostic procedures. Pathology does not threaten with serious complications, with the exception of other complex diseases that can affect it. For example: if a baby or an adult has hemodynamic problems upon detection of heart defects, including a mitral or tricuspid valve or a ductus arteriosus.

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

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

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

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

Diagnostic methods

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

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

Therapeutic measures

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

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

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

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

Preventing complications

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

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

Open oval window in a newborn: what is it?

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

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

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

Causes

The exact reasons 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 by the mother or father;
• drug addiction of parents;
• phenylketonuria or diabetes mellitus in the mother;
• taking certain medications during pregnancy (some antibiotics, lithium preparations, phenobarbital, insulin, etc.);
• prematurity of the child;
• connective tissue dysplasia, etc.

Symptoms

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

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

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

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

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

Possible complications

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

Diagnostics

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

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

Treatment

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

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

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

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

Open oval window in the heart (OOO) - a gap in the wall formed between the right and left atrium. Normally, such an open gap functions during the period of embryonic development and is completely overgrown during the first year of a child's life. If this does not happen, the talk begins about the anomaly, which is assigned the code Q21.1 in ICD 10.

On the left atrial side, the opening is covered by a small valve, which is fully mature at the time of delivery. When the first cry of a baby who was born occurs, and the lungs opened, there was a significant increase in pressure in the left atrium, under the action 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 a valve accretion occurs during the first year of life. This is the norm. But if the size of the valve is insufficient, the gap may not close completely, that is, some kind of hole will remain, the dimensions of which are determined in millimeters. Because of this, the atria are not isolated from each other. Then, which in another way is called MARS syndrome.

Cardiologists classify it as.

In some cases, when there are no severe symptoms that affect the quality of life, this syndrome can 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 come to an end. Some young people believe that because of this they will not be allowed into the army. Are there any reasons for such concerns? To understand this, you need to understand the causes, symptoms, and other factors associated with LLC.

Causes

So, an open oval window 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 left atrial cavity is higher. When a diagnosis is made, it is often phrased as follows: LLC with left-right discharge.

But LLC is not, although in accordance with the ICD 10 code they are assigned one. 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 state of the oval window are not always precisely known. It is believed that a hereditary predisposition can lead to this condition. Of course, there is hardly anything that can be done about this factor. But there are other reasons, which largely depend on the woman who carries new life, their presence is of particular importance during the period of wearing in the womb of a child:

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

Unfortunately, today more and more women are beginning 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. An open oval window is just one consequence that can be called not very serious compared to others, which may be, for example, a heart defect.

An open oval window can develop due to poor environmental conditions

LLC can develop for other reasons: poor environmental conditions, connective dysplasia, prematurity of the child. If these reasons take place 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 noticed that MARS syndrome is often manifested in other cardiac malformations. These include open aortic valve disease, as well as congenital mitral and tricuspid valve disease.

Several other factors may contribute to the opening of the window:

• very strong physical activity, especially for athletes who are involved in weightlifting, diving, power sports;
• manifestations of pulmonary embolism in those patients who have thrombophlebitis of the lower extremities and small pelvis.

Symptoms

Although the anomaly is often diagnosed in adults when examined for other conditions, it is best to do so early because other heart problems may be identified. Due to the identified symptoms, an adult or a child's parents can apply for medical care, undergo an examination, after which a diagnosis will be made: LLC with a left-right discharge, and the code will also be marked 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, as this is a common situation for a small child. Therefore, there are no special manifestations.

By the way, all children under one year old are assigned an ultrasound of the heart, which allows you to identify LLC. If the size of the defect is more than three mm, most likely, some signs will be observed that allow one to draw certain conclusions:

• nasolabial triangle or lips of a child, when he cries heavily, screams;
• frequent colds, bronchitis, pulmonary inflammation;
• slowing down of 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 short of breath.

The last signs are observed when the size of the anomaly exceeds the indicators of three mm. If the doctor suspects that the LLC is present in the child, he sends him for examination by an experienced cardiologist, for an ultrasound scan. This is how the dimensions of the defect are specified, it turns out that they exceed three mm. All this allows us to understand if there is any reason for concern. By the way, the size of the open window can be up to 19 mm.

Cyanosis of the nasolabial triangle may indicate an open oval window larger 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 symptoms that were listed above. There may also be a violation of the mobility of body parts, periodic numbness of the limbs.

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

Diagnostics

First, the doctor collects general data about the patient's health, history, complaints. This will help identify the reasons possible complications... A physical examination is also carried out, that is, the doctor examines skin, determines body weight, measures blood pressure, listens to heart sounds.

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

In addition, the picture is clarified by such studies as coagulogram, ECG, Echo KG, transesophageal, contrast echocardiography, chest X-ray.

All this allows you to accurately assess the state of health of the patient, 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 an open oval window with left-right collection or another similar diagnosis is detected?

Treatment

What if there is a suspicion of problems with the oval cardiac window? Go to the doctor immediately! This rule applies to everyone who discovers at least some kind of health problem. What to do after seeing a doctor? Follow his recommendations and appointments.

The scope of therapeutic measures is determined depending on the symptoms and concomitant diseases. Although the ICD 10 abnormality code is an atrial septal defect, an open foramen ovale in the heart with a left-right discharge is a different condition.

If there are no obvious violations in the cardiac work, the doctor gives the patient recommendations that are aimed at the correct organization of the daytime regimen, limiting physical activity, and adhering to dietary rules. Taking medications with an asymptomatic course of the anomaly is not advisable. General strengthening procedures, such as exercise therapy, treatment in sanatoriums, and others, can be prescribed.

With minor complaints about the work of the heart and blood vessels, vitamins and means to strengthen the muscles of the heart can be prescribed

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

• antiplatelet agents, anticoagulants, these drugs prevent blood clots;
• endovascular treatment, when a patch is applied to the oval window through a catheter, which stimulates the clogging of the hole with connective tissue, this patch dissolves on its own after a month.

Antibiotics are given 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.

In no case should you prescribe drugs yourself. Each remedy has contraindications, side effects... For these and other reasons, each appointment must be made by a physician. When the diagnosis is made: an open oval window 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's important to understand that complications are rare. In fact, such diseases can develop:

• renal infarction;
• stroke;

If an open oval window is detected, it is necessary to regularly observe a cardiologist and conduct an ultrasound of the heart

This is due to the fact that a paradoxical embolism develops. If we talk about forecasts, then in most cases everything is favorable. Those who have an LLC in accordance with ICD 10 need to be monitored regularly by a cardiologist and an ultrasound of the heart should be performed. It is necessary to give up sports, due to which the body is constantly exposed to very strong physical stress.

It is important for every woman who is planning to have a baby or has already become pregnant that it is important to remember that she can prevent the development of a heart anomaly in her unborn child. You cannot smoke, drink, take drugs and do anything that can somehow affect the health of the fetus in the baby's 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 different factors... But the health of each person is very often in his hands! Every day you need to think about your health, yours and your loved ones!