Causes of patent oval window in the heart and indications for treatment. Foramen ovale in the heart in adults: its formation and danger Open oval window 7 mm in an adult

A diagnosis such as open oval window, has become a fairly common find, thanks to the widespread introduction of methods into practice ultrasound diagnostics, in particular ultrasound of the heart. This phenomenon can be detected both in childhood and in adulthood, but when this is a pathology and when it is not, you will find out from the article.

Open oval window: normal variant

The adult heart has 4 chambers: 2 ventricles and 2 atria. Moreover, the right and left chambers are separated by partitions: interventricular and interatrial, which prevent blood from mixing from one part of the heart to another.

The oval window is essentially an opening (hole) between the two atria. But is the situation when the oval window can function always a manifestation of pathology? During intrauterine development In the fetus, a functioning oval window is the absolute norm.

The fetus, while in the mother's womb, receives nutrients and breathes through the umbilical cord. Lungs developing child do not function, so the pulmonary circulation, which begins from the right ventricle and ends in the left atrium (LA), does not work. In order for only a small part of the blood to reach the lungs, part of it is dumped from the right to the left atrium. This is precisely the main function of the LLC (open oval window).

Thus, the blood that flows into the RA (right atrium) flows partially into the left atrium through a functioning open oval window. It is important to note that reverse blood flow is not possible, because an open foramen ovale in children has a valve that prevents this.

At the moment a child is born, with his first breath, the pulmonary circulation begins its work. Function open window in the heart, which was necessary earlier, is no longer needed. In the LA (left atrium), the pressure in a person is normally slightly higher than in the right, therefore, when blood enters it from the pulmonary veins, it seems to put pressure on the valve of the open oval window in children, predisposing it to rapid overgrowth.

Unclosed oval window in childhood

An open foramen ovale in newborns is the absolute norm. It does not close immediately, but gradually. This occurs due to the growth of the window valve to its edges. Typically, within a period of 3-4 months to 2 years, an unclosed window will no longer be detected. For some, it can remain open for up to 5 years, which is also not a pathology. Thus, an open foramen ovale is not a pathology in either a newborn or an infant.

If the oval window does not close later, then this can be detected by ultrasound of the heart, then this pathology is called, or MARS, which is not a true defect.

Causes

Today, there are many assumptions about the reasons that may lead to a situation where an open foramen ovale in a child’s heart does not close. Here are the most common ones:

hereditary predisposition - probably due to the fact that the valve of the oval window has a smaller diameter, which does not allow it to close;
the presence of congenital heart disease (), most often these are defects of the mitral, tricuspid valves and patent ductus arteriosus;
prematurity;
dysplasia connective tissue;
smoking, drinking alcohol and medicines mother during pregnancy;
effect on the body of a pregnant woman harmful factors environment.

Hemodynamics

Since the oval window, located on the oval fossa in the area of its bottom, has a valve structure, the flow of blood from the left atrium to the RA becomes almost impossible, despite the difference in pressure. For the most part, this minor anomaly in the heart does not lead to hemodynamic disturbances. However, in cases where, for certain reasons, there is high blood pressure in the area of the right atrium (pregnancy, severe respiratory disorders), blood shunting from right to left is possible. As a result, less blood enters the pulmonary circulation (pulmonary circulation), and oxygen deficiency develops. lung tissue, as well as blockage by emboli and blood clots is vital important organs: heart, brain, kidneys with the development, respectively, of stroke and renal infarction

Symptoms in children and adults

Signs of a patent foramen ovale in young children are usually subtle and nonspecific. Parents can pay attention to the following manifestations in their infants:

during feeding, crying, straining or coughing, the baby’s nasolabial triangle acquires a bluish tint;
presence of shortness of breath in the same situations (crying, feeding, etc.);
rapid heartbeat;
refusal to eat;
low weight gain, delayed physical development.

Open foramen ovale in the heart in children adolescence and in an adult, it also usually does not interfere with human life and has an asymptomatic or low-symptomatic course.

Pathology can be suspected by indirect symptoms similar to those:

cyanosis or blanching of the nasolabial triangle, which occurs due to physical activity;
some symptoms pulmonary insufficiency(shortness of breath, rapid pulse);
low exercise tolerance (appearance of fatigue when executing them);
predisposition to diseases of the respiratory system (ARVI, bronchitis, pneumonia);
fainting;
headaches, including migraine-like;
violation cerebral circulation(extremely rarely - with paradoxical embolism in people suffering from varicose veins veins and thrombophlebitis of the lower extremities).

Diagnostics

The diagnosis can be made based on the following data:

An examination that includes listening to the heart: in this case, the doctor will hear a murmur in the heart, which occurs due to improper blood flow.
Electrocardiography: In adults, signs of right atrium/ventricular overload may be observed.
X-rays chest, in which you can also indirectly see an overload of the right atrium, which will manifest itself as an expansion of the heart shadow to the right.
Ultrasound examination of the heart with Doppler: this method is the most informative. Signs of an open oval window will be:

hole dimensions are about 4.5 mm (can vary from 2 mm to 5 mm);
the valve of the oval window, which is visualized in the left atrium;
the interatrial septum is thinner in the area where the oval window is located;
The defect is not always visible.

To more accurately obtain information and visualize the oval window, it is recommended to perform transesophageal echocardiography in adolescents, as well as in adults.

Angiography: an invasive technique that allows you to look “from the inside” at the condition of blood vessels. Performed according to strict indications in a hospital setting.

Treatment

If the presence of an open oval window does not have subjective complaints and manifestations, then no special therapy is required in either children or adults. It is recommended to perform an annual ultrasound examination of the heart to monitor the size of the window and blood flow. Also for such patients they give general recommendations by lifestyle:

limiting excessive physical activity;
avoiding sports such as diving, weightlifting, scuba diving, diving;
performing physical therapy;
balanced diet;
correct work/rest schedule.

If there are no symptoms, but there are risk factors (a history of an episode of ischemic attacks of the brain, the presence of varicose veins), then for such patients it is advisable to use anticoagulants (warfarin) and antiplatelet agents (cardiomagnyl).

The situation when the discharge of blood from the right atrium to the left has acquired significant values, a serious overload of the right atrium has occurred, it is shown surgical treatment. This surgical intervention performed through the femoral vessel under X-ray control. A catheter is inserted through a vein, at the end of which there is an occluder device. By bringing it to the area of the open oval window, the occluder completely closes the hole.

External view of the occluder for the operation to completely close the LLC

Thus, a patent foramen ovale in the heart is not a heart defect and most often does not pose a serious threat to the patient’s life and quality of life. However, it is still worth undergoing regular examination by a cardiologist and performing echocardiography, because with a large hole diameter and the presence of accompanying factors, dangerous complications can develop.

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

What is the “oval window” in the heart?

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

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

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

But first things first:

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

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

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

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

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

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

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

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

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

Types of oval window according to the degree of nonfusion

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

How does the disease manifest?

For a small oval window external manifestations may be missing. Therefore, the attending physician can judge the severity of the nonunion.

For infants with an open oval window, it is typical:

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

Paleness of the skin;
Increased heart rate in infants.

Adults with pathology may also experience bluish lips with:

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

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

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

Diagnostic methods

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

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

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

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

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

How dangerous is the pathology?

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

Methods of treatment and prevention of complications

If the course of the pathology is favorable and the size of the oval window is small, according to cardiac ultrasound, no specific treatment is required. However, this category of people must be registered with a cardiologist and undergo a heart examination once a year.

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

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

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

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

Surgery

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

Currently, endovascular surgery has become widespread.

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

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

Disease prognosis

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

Pregnancy and childbirth in women with the defect

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

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

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

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

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

conclusions

Due to the development additional methods Research and detection of such anomalies as a patent foramen ovale has increased significantly.

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

The presence of the foramen ovale deserves special attention large sizes, which is essentially an analogue of the defect interatrial septum. In this situation, surgical correction is recommended for patients.

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

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

In what cases is this normal?

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

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

Important! Because kids experience heavy loads, and, taking into account their unprepared body, the oval recess still works: during feeding, if the child cries or screams, the pressure in the right zone of the heart becomes higher.

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

Symptoms of pathology

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

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

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

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

Main factors

The reasons that there is an open oval window of 2 mm or larger in the heart are different, they are influenced by the physiological characteristics of the body of each individual person. On this moment no proven scientific theories or assumptions that could fully justify and confirm specific reasons pathology. When the valve does not fuse with the edges of the oval window, the cause is various factors. Echocardiography or ultrasound of the heart can reveal the presence of LLC.

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

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

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

Signs depending on age

Standard signs in newborns or adolescents are not recorded when an open oval window occurs in the interatrial septum, and often the presence of a defect is discovered by chance, for example: during echocardiography and other diagnostic procedures. The pathology does not threaten serious complications, with the exception of other complex diseases that may affect it. For example: if a child or adult has hemodynamic problems when heart defects are detected, including a mitral or tricuspid valve or ductus arteriosus.

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

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

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

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

Diagnostic methods

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

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

Treatment measures

The method of treatment for a child or adult depends on age, the presence of additional pathologies and whether the patient has signs of pathology or not. If there are no symptoms, and the defect is not accompanied by additional problems, the patient’s health does not worsen, you just need to be examined by a pediatrician, therapist and cardiologist. Doctors will be able to assess the condition of the oval depression and take appropriate measures in time and prescribe treatment. If the window doesn't close in a natural way up to five years, then corrective medications are prescribed.

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

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

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

Preventing complications

Complications may arise 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 a patent foramen ovale usually receive thromboembolic prophylaxis if surgery is to be performed. Such measures include taking anticoagulants or bandaging the legs, and a number of additional techniques. Often with this problem, symptoms of cardiac conduction problems and blood pressure disorders may occur.

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

Open foramen ovale in a newborn: what is it?

The oval window in the heart is a hole developed in utero, covered with a special fold-valve, which is located on the septum between the atria. This window communicates between the right and left atria of the fetus during the embryonic period. Thanks to it, part of the oxygenated placental blood can flow from the right atrium to the left, bypassing the non-functioning lungs of the unborn baby. This ensures normal blood supply to the head, neck, brain and spinal cord.

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

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

Causes

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

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

Symptoms

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

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

More often, a patent foramen ovale in newborns is asymptomatic or accompanied by mild symptoms. Indirect signs This anomaly in the structure of the heart, by which parents may suspect its presence, can be:

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

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

Possible complications

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

Diagnostics

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

After confirmation of this diagnosis and in case of exclusion of other heart pathologies, it is recommended that the child dispensary observation with a mandatory repeat ultrasound of the heart once a year to assess the dynamics of cardiac anomalies.

Treatment

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

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

The need to eliminate a patent window in newborns is determined by the volume of blood discharged into the left atrium and its effect on hemodynamics. At minor violation blood circulation and the absence of accompanying birth defects hearts surgery not required.

At pronounced violation hemodynamics, a low-traumatic operation for endovascular transcatheter closure of the hole with a special occluder may be recommended. This surgical intervention is performed under radiographic and endoscopic equipment. To the right atrium through femoral artery a special probe with a “patch”-plaster is inserted. This “patch” blocks the lumen between the right and left atrium and stimulates its overgrowth with its own connective tissue. After performing such an operation, the patient is recommended to take antibiotics for six months to prevent the occurrence of endocarditis. After this, the patient can return to his normal lifestyle without any restrictions.

Our article is devoted to this common pathology. This material will reveal to you the essence of the problem of a functioning oval window.

In 1930, scientists studied about 1,000 children's hearts, and as a result, about 35% of the subjects had a patent foramen ovale (PFO). Nowadays, the frequency of this phenomenon reaches 40% in the pediatric population.

Why does the fetus need an oval window?

In the womb of the mother, the child does not breathe literally This word, since the lungs cannot function, resembles a deflated balloon. A patent foramen ovale in newborns is a small opening between the atria. Through the oval window, blood from the veins flows into the single large circulation of the fetus.

After birth, the baby takes his first breath, the lungs begin their work. Under the influence of the pressure difference, the open oval window is closed by a valve. But such a valve may be too small to completely tighten the hole.

A functioning foramen ovale is an anomaly of the heart, and in no way a defect.

There is no exact cause for this pathology.

Highlight Some of the most common factors.

In almost all premature and immature newborns, the window remains open.
Smoking, maternal substance abuse.
Prolonged labor, asphyxia of the baby during childbirth.
Adverse environmental factors.
Mother's stress.
Genetic predisposition.
Congenital heart defects.
Occupational exposure to toxic substances in the mother.

Open oval window in children and its symptoms

In most cases, such children do not complain.

Therefore, it is very important for mothers to be attentive and monitor the slightest deviations in the behavior of their babies.

What can you notice?

The appearance of blueness around the mouth of a newborn. This cyanosis appears after crying, screaming, sucking, or bathing.
In older children, tolerance (resistance) to physical activity decreases. The child rests and sits down after regular outdoor games.
The appearance of shortness of breath. In general, a child should normally be able to easily climb to the 4th floor without any signs of shortness of breath.
Frequent colds in infants, namely: bronchitis, pneumonia.
Doctors listen for a heart murmur.

PERSONAL EXPERIENCE. The child is 10 days old; while bathing, the mother notes the blueness of the nasolabial triangle. The child was born full-term, weighing 3500. The mother admitted that she smoked during pregnancy. On examination, a murmur was noted at the apex of the heart. The baby was sent for an ultrasound. As a result, an open oval window of 3.6 mm was revealed. The child has been registered.

Ultrasound of the heart is of primary clinical significance. The doctor clearly sees a small hole in the projection of the left atrium, as well as the direction of blood flow.

When listening to a heart murmur, the pediatrician will definitely refer your baby for this type of examination.

According to new standards, at 1 month all newborns must undergo ultrasound screening, including the heart.

As a rule, there are no pathological changes on the ECG with LLC.

In 50% of children, the oval window functions for up to a year and then closes on its own; in 25%, fusion occurs by the fifth year of life. In 8% of the adult population, the window remains unlocked.

What to do if the window has not closed after 5 years? Basically, nothing. The open foramen ovale in a newborn is too small in size to ensure overload of the atria with the development of heart failure. Therefore, it is necessary to dynamically monitor the baby, undergo an annual heart ultrasound and be examined by a pediatric cardiologist.

PERSONAL EXPERIENCE. At the reception there was a 13-year-old boy. For 4 years the child has been involved in active sports – rowing. By chance, during a medical examination, an ultrasound of the heart was performed, where an oval window measuring 4 mm was first discovered. At the same time, the child did not show any complaints throughout his 13 years and coped well with physical activity. He even took first place in competitions.

If a child has complaints, he is prescribed drug therapy in the form of cardiotrophic drugs and nootropics - Magnelis, Kudesan, Piracetam.

These drugs improve myocardial nutrition and exercise tolerance.

Recently, it has become reliable that the drug levocarnitine (Elkar) promotes rapid closure of the oval window if taken for 2 months in a course 3 times a year. True, it is not entirely clear what this is connected with. From personal experience, I can say that I did not see a clear connection between Elkar’s appointment and the closure of the LLC.

But it still happens that the oval window can lead to poor circulation and heart failure. In pediatric practice, this is rare, in most cases it occurs by the age of 30-40. Then the issue of surgical intervention to close this hole is decided. A small patch is applied endovascularly (that is, using a catheter) through the femoral vein.

As for sports and a functioning oval window, if there are no complaints and good cardiac ultrasound indicators, you can engage in any kind of sport.

Complications

They are quite rare. Associated with embolism and impaired blood flow. These are heart attacks, strokes and kidney infarctions.

These complications can already occur in adults. And such a patient should always warn the doctor that he has a functioning foramen ovale.

Minor heart anomalies for the most part do not harm the health of children. Some famous athletes have this pathology and become Olympic champions. Many doctors consider LLC normal. But it should be remembered that annual supervision by a specialist is necessary.

Article publication date: 02/10/2017

Article updated date: 12/18/2018

From this article you will learn: in which cases an open foramen ovale in a child’s heart is a normal variant, and in which cases it is a heart defect. What happens with this condition, can an adult have it? Treatment methods and prognosis.

The oval window is a canal (hole, course) in the area of the interatrial septum of the heart, providing unilateral communication between the cavity of the right atrium and the left. It is a vital intrauterine structure for the fetus, but after birth it must close (overgrow) as it becomes unnecessary.

If healing does not occur, the condition is called a patent foramen ovale. As a result, oxygen-poor venous blood continues to be discharged from the right atrium into the cavity of the left. It does not enter the lungs, where it should be ejected from the right half of the heart to be saturated with oxygen, but immediately, once it reaches the left side of the heart, it spreads throughout the body. It leads to oxygen starvation– hypoxia.

Staying open after birth is the only violation of the oval window. But not in all cases this is regarded as a pathology (disease):

Normally, in all newborns the window is open and can function periodically.
Overgrowth occurs gradually, but individually for each child. Normally, in children older than one year, this channel should be closed.
The presence of a small open area of the oval window in children aged 1–2 years occurs in 50%. If there are no manifestations of the disease, this is a normal variant.
If a child has symptoms in the first year of life, and also if the oval window functions in children older than 2 years, this is a pathology - a minor anomaly of heart development.
For adults and children over 2 years of age, the window should be closed. But under certain circumstances, at any age, it can open, even if it is overgrown in the first year of life - this is always a pathology.

This problem is treatable. Treatment is carried out by cardiologists and cardiac surgeons.

What is a patent oval window for?

The heart of the fetus in the womb contracts regularly and provides blood circulation to all organs except the lungs. Oxygen-enriched blood reaches the fetus from the placenta through the umbilical cord. The lungs do not function, and the underdeveloped vascular system in them does not correspond to a formed heart. Therefore, blood circulation in the fetus bypasses the lungs.

This is what the oval window is intended for, which dumps blood from the cavity of the right atrium into the cavity of the left atrium, which ensures its circulation without entering the pulmonary arteries. Its peculiarity is that the hole in the septum between the atria is covered by a valve on the side of the left atrium. Therefore, the oval window is capable of providing only one-way communication between them - only right to left.

Intrauterine blood circulation in the fetus occurs according to the following scheme:

Oxygenated blood flows through the umbilical cord vessels into the fetal venous system.
Through the venous vessels, blood enters the cavity of the right atrium, which has two exits: through the tricuspid valve into the right ventricle and through the oval window (an opening in the septum between the atria) into the left atrium. The vessels of the lungs are closed.
The increase in pressure during contraction pushes back the oval window valve, and part of the blood is dumped into the left atrium.
From it, blood enters the left ventricle, which ensures its movement into the aorta and all arteries.
Through veins connected to the umbilical cord, blood enters the placenta, where it mixes with the mother's.

The oval window is an important structure that provides blood circulation to the fetus during the intrauterine period. But after the birth of a child, it should not function and gradually overgrows.

Possible development of pathology

At birth, the fetal lungs are well developed. As soon as the newborn baby takes his first breath and they are filled with oxygen, the pulmonary vessels open and blood circulation begins. From this moment on, the baby's blood is saturated with oxygen in the lungs. Consequently, the oval window becomes an unnecessary formation, which means it must heal (close).

When this happens - the process of overgrowing

The process of closing the oval window occurs gradually. In every newborn it can function periodically or constantly. But due to the fact that after birth the pressure in the left cavities of the heart is much higher than in the right, the window valve closes the entrance to it, and all the blood remains in the right atrium.

Children of the first year of life

The smaller the child, the more often the oval window is open - about 50% of children under one year old. This is an acceptable phenomenon and is associated with the initial degree of development of the lungs and their vessels at the time of birth. As the child grows, they expand, which helps reduce pressure in the right atrium. The lower it is in comparison with the left one, the more tightly the valve will be pressed, which should be firmly fixed (fused with the walls of the window) in this position for life.

Children of the second year of life

It happens that the oval window only partially closes (1–3 mm remains) by 12 months (15–20%). If such children develop normally and do not have any complaints, this is not considered a deviation from the norm, but requires observation, and by two years it should completely close. Otherwise, it is regarded as a pathology.

Adults

Normally, in children over two years of age and in adults, the oval window should be closed. But in 20% it either never heals or re-opens throughout life (and then is from 4 to 15 mm.

Six reasons for the problem

Six main reasons why the oval window does not heal or open:

Harmful effects on the fetus (radiation, toxic substances, medications, intrauterine hypoxia and other complicated pregnancy options).
Genetic predisposition (heredity).
Prematurity.
Underdevelopment (dysplasia) of connective tissue and heart defects.
Severe bronchopulmonary diseases and pulmonary embolism.
Constant physical stress (for example, crying or coughing for young children, intense exercise and sports for adults).

Pathological signs and symptoms

The discharge of oxygen-poor blood through the open foramen ovale into the heart leads to oxygen starvation in all organs and tissues - to hypoxia. The larger the diameter of the defect, the greater the discharge and the stronger the hypoxia. This can cause the following symptoms and manifestations:

About 70% of people with open channel do not make any complaints. This is due to the small size of the defect (less than 3–4 mm).

How to diagnose the problem

Diagnosis of pathology - ultrasound of the heart (echocardiography). It is better to perform it in two modes: standard and Doppler mapping. The method allows you to determine the size of the defect and the nature of circulatory disorders.

Image of a large patent foramen ovale during cardiac ultrasound. Click on photo to enlarge

Treatment

In deciding questions about the need for treatment and choice optimal method two factors are taken into account:

Are there any symptoms or complications:

if yes, surgery is indicated, regardless of the size of the defect;
if not, treatment is not required in both children and adults.

What are the dimensions of the defect and the amount of blood discharge according to echocardiography: if they are pronounced (more than 4 mm in a child) or there are signs of cerebral blood flow disorders in adults, surgery is indicated.

The oval window can be easily closed using a procedure that is performed without a single incision through a puncture of one of the large arteries.

Endovascular surgery to close the oval window in the heart

Forecast

The asymptomatic course of an open oval window in adults and children does not pose any threats and restrictions in 90–95%. In 5–10% of cases, when unfavorable circumstances (lung disease, heart disease, hard work) are added to this anomaly, a gradual increase in the defect is possible, resulting in clinical manifestations and complications. Operated patients recover in 99%. All adults and children with a patent foramen ovale should visit a cardiologist once a year and undergo an ultrasound of the heart.