Patent foramen ovale 3 mm in a child. Patent foramen ovale in the heart in newborns, adolescents and adults: a problem that needs to be treated? Norms for LLC sizes in newborns

The patent foramen ovale in the heart is a small hole located in the septum directly between the right and left atria. Normally, they should not communicate with each other to prevent mixing of arterial and venous blood, as well as pressure changes. This condition is a pathological phenomenon in adults and children of a certain age and is very common. Sometimes the disease does not cause serious physical discomfort, but in some cases it can lead to various disorders in the functioning of the cardiovascular system and requires treatment.

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

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

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

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

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

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

Symptoms

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

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

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

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

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

Possible complications

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

myocardial infarction;
kidney infarction;
stroke.

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

Treatment of the disease

If a medical examination reveals an open depression in the heart, but it does not bring any physical discomfort to the person, then no special treatment is performed. For minor complications, various drugs are prescribed to prevent the formation of deep vein thrombosis.

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

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

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

Forecast

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

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

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

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

In what cases is this normal?

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

Diagram of a heart with two pathologies

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

Important! Since babies experience great stress, and taking into account their unprepared body, the oval cavity 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 take 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. At the moment, there are no proven scientific theories or assumptions that could fully substantiate and confirm the specific causes of the pathology. When the valve does not fuse with the edges of the oval window, the cause is various factors. Echocardiography or ultrasound of the heart can reveal the presence of LLC .

Septum in pathology

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 stress, smoking or drinking alcohol by the mother during pregnancy, or constant contact with toxic components. An open foramen ovale in the heart remains in an adult if developmental abnormalities, slow growth or prematurity are detected in childhood.

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

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

Signs depending on age

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

Diagnosis of pathology

Symptoms of such a defect as a patent oval window appear in both infants and adolescents , 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;
when listening at an appointment with a cardiologist.

In some adults, pathology is accompanied by characteristic symptoms and can be temporary or permanent. Sometimes the functional window opens after overgrowth in the presence of special pathologies, if the pressure in the area of the right atrium gradually increases. An open foramen ovale appears in a pregnant woman, with complex pulmonary insufficiency or when a pulmonary artery is blocked. Despite the almost complete absence of 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 of the right bundle branch;
migraine;
gradual development of a heart attack or stroke;
short-term shortness of breath.

Diagnostic methods

Before prescribing complex therapy and confirming the pathology, a specialist usually prescribes diagnostics, 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.

Ultrasound of an open oval window

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. Imaging through echocardiography is the 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 does not close naturally before the age of five, corrective medications are prescribed.

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

The risk group consists of patients who do not have pronounced symptoms, but are likely to experience ischemia, heart attack, stroke, pathologies of the veins in the legs or other diseases. 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 is an additional way to solve the problem, which is a special patch inserted through a catheter, which then opens into the atrium. It regenerates tissue well and dissolves on its own within thirty days.

Preventing complications

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

During the process of intrauterine development, some “imperfections” of embryogenesis are often observed. Such deviations are referred to as minor anomalies (MARS).

They are not regarded as congenital malformations. One of the widely diagnosed variants is the patent oval window (PFO).

Normal blood circulation in the fetus and newborn

A patent foramen ovale in the heart is a natural anatomical structure during fetal development.

In the fetus, only the systemic circulation functions. The small circle is closed due to the lack of breathing through the lungs.

The consequence of this is the exclusion of the right ventricle and left atrium from the work of the cardiovascular system. Therefore, the body responds with a temporary protective reaction in the form of LLC.

The localization of this structure is the middle part of the interatrial septum. The window begins to open at 3 weeks, when the heart begins to beat. Its dimensions do not exceed 0.5 cm.

Anatomically, in this place there is an oval fossa, in which there is an opening for the reverse discharge of blood. The distinctive part of this formation is the closing valve.

It plays an important role in the further formation of normal blood circulation.

After the baby is born, the lungs begin to function at the first cry. At the same time, the pulmonary circulation is turned on.

Due to a sudden and sharp increase in pressure in the left atrium, the valve of the foramen ovale closes. The communication between the cavities disappears.

If there is a deviation during this process, then a functioning oval window is formed after birth. This anomaly is not classified as a defect due to its favorable prognosis. It closes by age 2 in most children.

Reasons for formation

The exact etiological factors contributing to the timely failure to close the oval window are not completely known. However, doctors note a higher percentage of detection of such an anomaly if there were possible causes:

From the mother's side:
hereditary nature of the minor anomaly;
difficult pregnancy (preeclampsia, frequent infections, threats of miscarriage);
alcohol abuse;
smoking;
diffuse connective tissue diseases;
radiation and radiation exposure;
chronic diseases that worsen the course of pregnancy (diabetes mellitus).
From the fetus:
prematurity;
individual anatomical features - the oval valve is small in size;
congenital defects and deformities;
chronic hypoxia;
lung pathology, including pneumonia of newborns.

Thus, the formation of an open window occurs in two ways:

The discrepancy between the small dimensions of the valve and the larger diameter of the hole when it “slams shut”.
Insufficient pressure in the vessels of the pulmonary circulation and the left atrium, which is accompanied by a lack of valve closure.

If LLC is formed along the 1st path, then such a small anomaly persists for many years, right up to old age. In case 2, spontaneous closure occurs in childhood.

Clinical picture

For many years, the oval window in the heart can be asymptomatic. You can suspect an anomaly in a newborn and older children based on the following signs:

weak sucking reflex;
small weight gain;
excessive regurgitation;
blueness of the nasolabial triangle during crying, straining, coughing, defecation;
some delay in physical development;
frequent respiratory infections;
fast fatiguability;
shortness of breath when doing physical education at school;
decreased exercise tolerance.

During pregnancy, a functioning open foramen ovale is accompanied by:

frequent changes in blood pressure;
heartbeat;
interruptions in heart function;
shortness of breath with minimal exertion;
recurrent acute respiratory infections.

An adult without concomitant diseases has no complaints. Symptoms occur during severe physical and emotional stress.

In such cases, the patient with a functioning oval window is concerned about:

long-term shortness of breath at rest;
heartbeat;
chest discomfort;
piercing pains in the region of the heart;
increased blood pressure;
blueness of lips.

The patient usually does not pay attention to these symptoms due to the fact that they pass quickly. In such cases, PFO is often a finding in diagnostic searches for other diseases.

Methods for detecting minor cardiac anomalies

After the baby is born, he is examined by a neonatologist in the first days of life. At the same time, the following are of medical interest:

mother's complaints about changes in skin color and problems with breastfeeding;
the nature of the ongoing pregnancy;
hereditary history;
weight gain curve;
during physical examination - auscultation of the heart and lungs;
data from additional studies.

When an adult visits a doctor, the following is also carried out:

Collection of complaints and anamnesis of life, illness.
Objective examination.
Laboratory tests.
Instrumental research methods:
Ultrasound of the heart;
Holter monitoring;
pulse oximetry (determining the degree of blood oxygen saturation);
X-ray of the chest organs.

During an objective examination, an experienced specialist may suspect a diagnosis of an oval patent window during auscultation of the heart due to additional noise, changes and accentuation of tones on the pulmonary artery. Often in such cases there is a displacement of the apical impulse.

From laboratory tests the following are prescribed:

Complete blood count to detect erythrocytosis (increased number of red blood cells due to blood thickening).
Biochemical study to determine the functioning of the kidneys, liver, lipid spectrum.

An ECG and its daily monitoring are carried out to assess possible rhythm disturbances and to identify ischemic disorders during exercise.

The only method that makes it possible to make a final diagnosis with an open foramen ovale is ultrasound of the heart.

At the same time, its size and signs of pulmonary hypertension are assessed. If a developmental anomaly is suspected, a study is prescribed from the first days of life.

Lead tactics

If a patent oval window is detected without pronounced clinical symptoms, doctors take a wait-and-see approach.

Children with this diagnosis are registered with a cardiologist, where an individual schedule for visiting a specialist and a research plan are drawn up. It explains to parents what MARS is and why it is important not to miss visits to the doctor.

For an open oval window measuring 2 mm or less, no medications are prescribed. The prognosis for such patients is favorable. In children, the formation of adult-type blood flow occurs by the age of 6 years.

By this time, in most cases, the closing of the window is noted. Treatment is usually not carried out. After the closure of the LLC, sports are not contraindicated.

If a newborn has a PFO of more than 3 mm, then at the age of 1 and 3 months. A visit to a cardiologist is indicated. In the absence of clinical symptoms, a further visit is scheduled at 1 year. During it, the dynamics of closing the LLC are assessed.

When a child has a large hole, severe symptoms and rhythm disturbances, surgical treatment is recommended.

If detected during pregnancy and in adulthood in the heart of an open foramen ovale, dynamic observation is indicated. If necessary, supportive and symptomatic drug therapy is prescribed.

Treatment options

In most cases, medical intervention is not required for PFO. However, in any case, treatment begins with general recommendations:

Limiting heavy physical activity.
It is prohibited to engage in professional sports.
Eating healthy and maintaining ideal body weight.
Elimination of bad habits: smoking, alcohol, strong coffee.
For bottle-fed children - formulas with increased calorie content.
Monitoring blood pressure and heart rate.
Reducing stressful and psycho-emotional situations.

The following medications may be prescribed by your doctor as maintenance therapy:

Magne-B6;
Panangin;
Mildronate;
Mexidol;
Elkar;
Actovegin.

Symptomatic treatment includes prescription:

antiarrhythmics;
blood pressure-normalizing drugs;
medications for blood thinning during thrombosis and thromboembolism - anticoagulants, disaggregants.

Surgical treatment is indicated at any age for severe hemodynamic disturbances, a high risk of complications and a severe clinical picture.

The essence of the operation is that the defect is closed with a special patch.

The intervention was well tolerated. It is carried out percutaneously - through the femoral or radial artery using a special probe with the introduction of a contrast agent. Complications are rare. After the operation, the patient is allowed to play sports.

LLC is not a congenital heart defect (CHD). The prognosis for life and work ability with such an anomaly is favorable. There is no need to treat it. The main thing is to visit a specialist for dynamic monitoring in order to prevent the development of undesirable consequences.

Science does not stand still, and new diagnostic methods make it possible to identify pathologies that were not even known about before. Today, many parents are told that the oval window in children’s hearts is open.

Many begin to worry and think about what could cause this illness. People should have these thoughts, because the little ones are our life, and their health is the most important thing.

Women need to know that a patent foramen ovale in the baby's heart is normal if they are in their womb, it closes after the baby is born. The fetus needs it to receive the necessary blood circulation and oxygen supply to the still developing organism. What kind of window this is, the reasons for its development, possible complications and treatment methods, you will learn in this article.

Oval window in the heart in children - description

Foramen ovale in the heart in children

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

In particular, in the septum separating the atria there is an opening called the oval window. Its presence is due to the fact that the fetal lungs do not work, and therefore little blood enters their vessels.

The volume of blood that in an adult is ejected from the right atrium into the veins of the lungs, in the fetus passes through the hole into the left atrium and is transferred to the more actively working organs of the baby - the brain, kidneys, liver and others. This window is separated from the left ventricle by a small valve that matures completely by the beginning of labor.

When the baby takes his first breath and his lungs open, blood flows into them, which is accompanied by an increase in pressure inside the left atrium. At this moment, the oval window is closed by the valve, and then it gradually fuses with the septum.

If the window closes prematurely, while still in utero, this threatens heart failure and even the death of the child, so the presence of an opening is important for the fetus. Closing the window occurs differently for different children. In some, the valve grows to it immediately after birth, in others - during the first year, in others - by the age of 5.

In some cases, the size of the valve is not sufficient to close the entire oval window, which is why the hole remains slightly open for life, and a small volume of blood is periodically discharged from the pulmonary circle into the systemic circulation.

This situation is observed in 20-30% of children. A foramen ovale that does not close completely after birth is not considered a defect in the septum that divides the atria, since the defect is a much more serious problem. It is considered a congenital defect, and LLC is classified as a minor anomaly, representing only an individual feature.

With a septal defect, the valve is completely absent and blood can be discharged from left to right, which poses a health hazard. There are open foramen ovale and other septal defects. The difference is that such a window always has a valve that regulates blood flow.

If there is a defect, the valve is absent, but there is a hole in the septum, which is visible during ultrasound examination. The oval window is not considered a heart defect; it is classified as a minor anomaly in the development of the cardiovascular system. In infants this is not yet a cause for concern, but in older children the anomaly should not lead to complications.

A serious complication is the so-called “paradoxical embolism” in the case of prolonged non-closure of the window. Emboli are small blood clots, bacteria, even bubbles that leak from venous blood into arterial blood through a window.

If they enter the vessels connecting to the brain, they can cause a bacterial complication or even a stroke. If the child is not at risk for blood clots, a fenestra abnormality may be relatively safe. Window dimensions:

If the window size is around 2 - 3 mm, then this is normal, this does not mean any deviations, so there will be no problems.
Small window size - up to 5 - 7 mm. Windows of 4.5 - 5 mm are more common. A hole of 7 mm or more is considered large, or “gaping,” and is treated surgically.
The maximum size can reach 19 mm. According to research, large windows are much less common among adults.

To understand the meaning of this window, let’s briefly consider what sections the child’s heart consists of. Please note that the human heart consists of four cavities, which are called “heart chambers”. These are two atria: right and left; and two ventricles: right and left.

One of the main functions of the heart is to ensure a constant flow of blood in the body (this function is called pumping). This occurs due to the constant contraction of the heart muscles. When the heart muscle contracts, blood from the chambers of the heart is pushed into the vessels that extend from the ventricles of the heart (arteries), and when it relaxes, the atria are filled with blood that comes from the vessels that flow into the heart (veins).

In adults, the right (atrium and ventricle) and left (atrium and ventricle) sections do not communicate with each other. The atria are divided by the interatrial septum, and the ventricles by the interventricular septum.

Blood circulation in a fetus occurs differently than in an adult. During the prenatal period, the baby has so-called “fetal” (fetal) structures in the cardiovascular system. These include the oval window, the aortic and venous ducts.

All these structures are necessary for one simple reason: the fetus does not breathe air during pregnancy, which means its lungs do not participate in the process of saturating the blood with oxygen. But first things first:

So, oxygenated blood enters the fetal body through the umbilical veins, one of which flows into the liver, and the other into the inferior vena cava through the so-called ductus venosus.

Simply put, pure arterial blood reaches only the fetal liver, because in the prenatal period it performs an important hematopoietic function (this is why the liver occupies most of the 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.

Purpose of an open oval window

The baby's heart develops in utero in such a way that communication between the right and left atrium is simply necessary to ensure the life of the fetus. Therefore, there is an open oval window in the fetal heart. When the baby is born and begins to breathe on its own, saturating the blood with oxygen (O2) in the lungs, the communication of the two atria is not vital and the oval window in the heart begins to gradually close.

The timing of its complete closure varies, but in most children the oval window closes by about one year of age; in some children (not always), the oval window in the heart is allowed to close at a later date.
Thus, a patent foramen ovale is one of the normal stages in which a baby's heart develops.

The human heart normally consists of two parts. Each of them has partitions made of connective tissue. The diagnosis of “patent foramen ovale” means that the hole in the septum between the atria has not completely closed. If the fetus does not have a patent foramen ovale or is not open enough, this can lead to intrauterine death.

Even if it was possible to survive in the womb of the mother, the child dies after birth, less often he develops right ventricular heart failure. Every newborn is born with a patent foramen ovale, which should normally close within one year.

It is very rare that the closing process lasts two or more years. The defect can be diagnosed using ultrasound. The mechanism of development of the anomaly has not yet been thoroughly studied, and its causes have not been fully established. Doctors believe that the factors contributing to the appearance of this defect are:

the birth of a child before the predetermined date when the baby is premature;
poor ecological state of the environment;
hereditary predisposition to diseases of the cardiovascular system;
exposure to chemicals on the body of a pregnant woman;
frequent stress and unstable psycho-emotional state of the child’s mother during pregnancy.

It is believed that the highest chances of developing an anomaly are in children whose mothers abused alcohol or drugs during pregnancy and breastfeeding. In a healthy child, the window is closed with a valve. This process happens slowly.

If, as a result of genetic predisposition, the size of the valve is smaller than the size of the window, the latter remains open, but the function of the heart is not impaired. If a child nevertheless develops this anomaly, most likely it will not be possible to get rid of it, but there is no need for this, because an open oval window in the heart in children has almost no effect on their life.

It has been noted that the anomaly is more often observed in premature infants. There is an opinion that the reasons may be smoking and abuse of alcohol or drugs by a woman during pregnancy. Other factors:

bad ecology;
heredity;
chemical exposure;
stress.

Due to genetic characteristics, the valve that closes the window is slightly smaller in millimeters compared to the hole, which is why it is not able to completely close it. As you can see, some of these reasons depend on the woman herself and her behavior.

If she wants her child to be born and be healthy, she will protect herself from any unfavorable factors. If it was not possible to avoid the anomaly, it is important to remember that it will most likely accompany him throughout his life, but in rare cases it affects work and everyday activities.

With normal development of a newborn, valve closure occurs already in the first 3 to 5 hours of life. Overgrowing of a window in children is a longer process, requiring from two months to two years. However, there have been cases where the window did not become overgrown for five years and even throughout life.

So a baby’s window is not yet a reason for concern and immediate treatment. It has been proven that an oval window is present in 35% of people, and in 6% of them, ultrasound revealed a diameter of more than 7 mm. Of these 6%, half are children under six months old.

What to do if the window has not closed, and by the age of 5-10 years the doctor announces: “the oval window is open”? In a child, the hole may not close tightly due to the structural features of the valve: genetically, it may be smaller than usual.

This happens in premature babies and in those who have been diagnosed with intrauterine developmental pathologies. A defect such as a patent foramen ovale in newborns does not refer to heart defects, but to minor anomalies of cardiac development (abbreviated MARS).

This means that the existing damage does not pose a major threat. People live for years without even suspecting that something is wrong with their hearts.

Another problematic situation is a completely open foramen ovale, when the valve between the atria does not perform its functions at all. This pathology is called atrial septal defect. If a diagnosis has been made, from the age of 3 the child is assigned health group II, and young men of military age are given fitness category “B”, which means limited suitability for military service.

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 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 that is fraught with an increase in pressure in the pulmonary vessels (long-term breath holding, 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.

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 foramen ovale ranging in size from 4.5-19 mm or incomplete closure by the valve, the child may experience transient cerebrovascular accidents, signs of hypoxemia and the development of such severe complications as 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 of this anomaly in the structure of the heart, by which parents may suspect its presence, may be:

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

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

The main diagnostic methods are:

With their help, you can confirm or refute the diagnosis, determine the size of the open window. These methods do not pose any danger to either the newborn or older children. They allow you to get a detailed picture of the anomaly, after which the doctor decides whether to simply monitor the condition of the heart or prescribe therapy.

When determining a treatment algorithm, the doctor must take into account the following indicators:

age of the child;
the health status of the little patient;
accompanying illnesses;
are there any allergies to drugs;
are there any contraindications?

Only an experienced doctor who has previously encountered similar cases in his practice can accurately diagnose. Since the disease does not manifest itself specifically, it can be detected by studying other pathological disorders.

The following signs should prompt you to consider referring a doctor to a cardiologist:

With exertion, cyanosis of the skin in the lip area appears.
Up to 10 years of age, a child may lag behind in development - both physically and mentally.
Children aged 13 to 15 years are less resilient than their peers.
Due to poor blood flow and insufficient supply to the respiratory system, the child develops diseases such as pneumonia and bronchitis.

If the defect is found in a newborn child, no therapy is carried out and no intervention is required.
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 an ultrasound examination of the heart, performed not through the chest, but the so-called transesophageal echocardiography. In this study, an ultrasound probe is inserted into the esophagus, as a result of which all 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).

Most often, MARS syndrome does not cause any complaints or complications. In these cases, no treatment is required. Some specific loads pose a risk of complications. In children who are many years old, blood can be shed during diving, paroxysmal coughing, or exercise, which is accompanied by holding their breath or straining.

Such children should not be exposed to scuba diving, weightlifting, or deep-sea diving year after year. Therefore, parents should not worry if their child has a PFO, but there are no other heart disorders, chronic diseases, or interference with blood circulation, no matter how old he is, everything is going well and the prognosis is favorable.

A patent foramen ovale in newborns is not a cause for concern! But for this to really be the case, doctors advise avoiding serious physical activity and monitoring your health and doctors. If the risk of blood clots is high, doctors prescribe anticoagulants.

If the size of the hole is large and blood is discharged from one atrium to another, surgery may be prescribed. It is based on inserting a catheter into the artery. At its end there is a special device that completely covers the oval window.

Depending on how old the child is, the doctor decides to perform such an operation or not. Antibiotics must be taken for six months after surgery to prevent the development of bacterial endocarditis. So, if the baby is only a year old and has OOO, you should wait, this condition may disappear.

If it persists, there is no need to worry either; today there are modern methods of treating this anomaly. There is every chance that the child’s health will not suffer! Treatment of PFO is not always required: in children under the age of 4 - 5 years, the window can close on its own.

At an older age, you should also not panic; medical supervision, ECG and EchoCG are necessary. Cardiologists recommend being examined every six months.

If the doctor detects a risk of blood clots, treatment under his supervision and the use of special blood thinning medications are recommended. Also in such cases, doctors advise avoiding excessive stress.
If the hole is larger than normal, surgical treatment may be required. It consists of inserting a tube with a special “closer” at the end, which completely removes the lumen between the atria.

According to experts, you need to monitor the child’s daily routine, nutrition, and not overload him (including psycho-emotionally). You should stick to protein foods in your diet, eat vegetables and fruits. You should also not run any infections, even the most seemingly insignificant ones. Any malfunction in the body can potentially affect the functioning of the heart.

An open oval window poses a danger to the life and health of a child if he is diagnosed with the following concomitant diseases:

pulmonary hypertension;
pathologies of the respiratory system;
thromboembolism.

Thromboembolism poses a particular danger to the health and life of a child, so it is necessary to take all measures to prevent its occurrence.

When blood clots enter the pulmonary artery, they spread to all internal organs:

Blood clots entering the brain vessels can cause a stroke.
If clots accumulate in the coronary vessels, myocardial infarction occurs.
When the arteries of the limbs become blocked, ischemia occurs and they can die.

Blood clotting increases, and at the same time the risk of blood clots increases if the patient has undergone massive surgical interventions, has been in an inactive state for a long time, and the following disorders have been diagnosed:

atrial fibrillation;
aneurysms of blood vessels and heart.

If these factors are present, the patient is prescribed blood thinning medications (anticoagulants). The dose and regimen are determined in each case individually.

Drug therapy can be indicated only for children with signs of heart failure, transient ischemic attack (nervous tics, asymmetry of facial muscles, tremors, convulsions, fainting) and, if necessary, the prevention of paradoxical embolism.

They may be prescribed vitamin-mineral complexes and drugs for additional nutrition of the myocardium:

Panangin,
Magne B6,
Elkar,
Ubiquinone,
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. In case of minor circulatory disorders and the absence of concomitant congenital heart defects, surgical treatment is not required.

There are cases when a surgical solution to the defect is indicated, but there must be good reasons for this. Surgery is prescribed in the following cases:

the diameter of the open window is more than 9 mm;
more blood is released than normal;
complications from the respiratory or cardiovascular systems appear;
the patient has limited activity;
There are contraindications to taking medications.

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 a local inflammatory reaction in the heart tissue. In this regard, the BioStar absorbable patch has recently been used. 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.

All manipulations are performed using the endovascular method (also called transcatheter closure). A catheter is installed on the right thigh, through which an occluder - an umbrella-like device on both sides - is delivered to the heart through the vessels using special instruments. Once the occluder is opened, the hole is securely plugged and the problem disappears.

The advantage of such interventions is obvious: there is no need to cut the chest, stop the heart, resort to artificial circulation, or use deep anesthesia. For a child who has undergone surgery in the first 6 months, antibiotic therapy is prescribed to prevent bacterial endocarditis.

So, an open oval window found in newborns is not a cause for alarm at all. If the window has not closed after 2-5 years, it is necessary to observe and consult a cardiologist. Discussions about what is “normal” and what is “pathology” are still ongoing.

Therefore, each case will be individual. However, most situations are not life-threatening and do not require treatment.

Many parents worry that the “hole in the heart,” as they call it, will endanger the child’s life. In fact, this problem is not dangerous for the baby and most children with an open window feel quite healthy.

It is only important to remember some restrictions, for example, in relation to extreme sports or professions in which the load on the body increases. It is also important to have your baby examined by a cardiologist every 6 months with an ultrasound examination.

If the foramen ovale remains open after the child's fifth birthday, it is most likely that it will not heal and will be with the child for the rest of his life. Moreover, such an anomaly has almost no effect on work activity. It will become an obstacle only to obtaining the profession of a diver, pilot or astronaut, as well as to strong sports loads, for example, weightlifting or wrestling.

At school, the child will be classified in the second health group, and when conscripted, a boy with LLC will be counted in category B (there are restrictions during military service). It is noted that at the age of over 40-50 years, the presence of PFO contributes to the development of coronary and hypertension.

In addition, during a heart attack, an unclosed window in the septum between the atria has a negative impact on the recovery period. Also, adults with an open window experience migraines more often and often experience shortness of breath after getting out of bed, which immediately disappears as soon as the person goes back to bed.

Among the rare complications of PFO in childhood, embolism may occur. This is the name for the entry into the bloodstream of gas bubbles, particles of adipose tissue or blood clots, for example, during injuries, fractures or thrombophlebitis.

When emboli enter the left atrium, they travel to vessels in the brain and cause brain damage, sometimes fatal. It happens that the presence of a patent foramen ovale helps improve health.

This is observed in primary pulmonary hypertension, in which shortness of breath, weakness, chronic cough, dizziness, and fainting occur due to high pressure in the vessels of the lungs. Through the oval window, blood from the small circle partially passes into the large circle and the vessels of the lungs are unloaded.

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

Even in the absence of pronounced symptoms, it is necessary to register the child with a cardiologist. The doctor should monitor the child regularly.
An open foramen ovale in the heart and sports accompanied by heavy loads are incompatible. Physical exercises should not contain strength exercises or excessive tension of the abdominal muscles.
The child should be protected from running, squats, jumping and anything that could provoke a shunt. The daily routine should be properly organized to balance the child’s periods of activity and rest. You need to include naps in your schedule.
Every 2 hours you need to do a little exercise and stretch your leg muscles to prevent the possibility of developing vein diseases in the future. Pay attention to the positions in which the child sits. Teach him to sit with the correct position of his legs: they should not be tucked in or folded crosswise.
The best way to prevent future stroke is to lead an active lifestyle to prevent blood stagnation in the lower extremities and prevent venous disease.
Experts recommend hardening and restorative procedures.
Children with this diagnosis need an annual holiday at a resort and regular walks in the fresh air.
Make sure your child has enough fluids to drink every day.

Do not let your child notice your concerns about his health - this can lead to panic and increased nervousness. This will not help improve his condition. Always be calm, good-natured and attentive to your child.

Take care of his mental comfort. And over time, transformations in the oval window of his heart will lead to its overgrowth. The main thing is to follow the recommendations of specialists.

There are no special methods for preventing an open oval window. To prevent a person from developing a patent oval window, his pregnant mother needs to lead a healthy lifestyle:

quit smoking and alcohol;
eat rationally and balancedly (limit consumption of fried, spicy, smoked foods, eat more foods high in fiber (vegetables, fruits, herbs).

Prevention of heart defects in the fetus (disorders of heart structures) includes several principles. A woman needs:

avoid contact with ionizing radiation (from X-ray machines, thermonuclear reactions);
with various chemicals (vapors of varnishes, paints, some medications);
avoid the occurrence of infectious diseases (a disease such as rubella is especially dangerous, which in most cases leads to congenital heart disease, deafness and cataracts (damage to the lens of the eye)

The human heart (a photo of the organ can be seen below) includes four chambers. They are separated by walls and valves. Next, we will understand how this organ functions and what the heart abnormality may be.

Circulation

From the inferior and superior vena cava the flow enters the right atrium. Next, the blood passes through the tricuspid valve, consisting of 3 petals. It then enters the right ventricle. Through the pulmonary valve and trunk, the flow enters the pulmonary arteries and then into the lungs. Gas exchange occurs there, after which the blood returns to the left atrium. Then through the bicuspid mitral valve, consisting of two petals, it enters the atrium. Then, passing through the aortic valve, the flow enters the aorta.

Anatomy

The vena cava enters the right atrium, and the pulmonary veins enter the left atrium. The pulmonary trunk (artery) and the ascending aorta emerge from the ventricles, respectively. The left atrium and right ventricle are the elements that close the pulmonary circulation, and the right atrium and left ventricle are the systemic circle. The organ itself belongs to the system of components of the middle mediastinum. Most of the anterior surface of the heart is covered by the lungs. With the outgoing pulmonary trunk and aorta, as well as with the incoming sections of the pulmonary and vena cava, the organ is covered with a kind of “shirt” - the pericardium, in the cavity of which there is a small volume of serous fluid, and a bursa.

General information about pathologies

One of the main tasks of medicine today is the treatment of heart disease. According to statistics, mortality from CVD pathologies is growing rapidly throughout the world every year. A study of the causes of diseases of the cardiovascular system has shown that some of them are caused by infection, others are hereditary or congenital. The latter are diagnosed quite often. As a rule, such pathologies do not manifest themselves and are detected exclusively during preventive examinations. However, there are several congenital pathologies, the clinical picture of which is obvious. So, for example, if the lumen in the aorta is too narrow, blood pressure increases greatly in the upper region and decreases in the lower region of the body. With such a congenital pathology, a complication may be a cerebral hemorrhage. Patients are often diagnosed with any holes in the septum. Also, the open foramen ovale in the heart may not heal, and the botal duct (the vessel connecting the aorta and artery in the prenatal period) may remain.

Against the background of these defects, a mixture of arterial and venous blood occurs, as a result of which insufficient oxygen is distributed throughout the body. As a result, cyanosis of the limbs and face begins, shortness of breath, the tips of the fingers specifically expand and become like drumsticks. In addition, the level of red blood cells increases. Saturation of the blood with oxygen is also hampered by aplasia or hypoplasia of the pulmonary artery.

Patent foramen ovale in the heart

It functions in humans during the embryonic period. During the first year of life, a child's open foramen ovale usually heals. However, in some cases this does not happen. The location of the hole is the interatrial septum. An open foramen ovale with non-closure can manifest itself as delayed physical development, cyanosis in the area of the nasolabial triangle, tachycardia and shortness of breath. Sudden fainting, headaches, bronchopulmonary pathologies and frequent acute respiratory viral infections are also observed.

An open foramen ovale in newborns is a necessary condition for the functioning of the cardiovascular system in the prenatal period. Thanks to the presence of this opening, a certain volume of oxygenated placental blood enters the left atrium from the right. In this case, the flow bypasses the non-functioning, undeveloped lungs, ensuring normal nutrition of the fetal head and neck, development of the spinal cord and brain.

Relevance of the problem

An open foramen ovale in newborns, under adequate developmental conditions, usually closes during the first year of life. However, infection occurs differently for everyone. By twelve months, an open oval window in a baby closes in 40-50% of cases. The presence of an unclosed hole after the first or second year of life refers to minor defects in organ development (MARS syndrome). An open foramen ovale in an adult is detected in approximately 25-30% of cases. This fairly high prevalence determines the relevance of this problem for modern doctors.

Fusion process

Newborns always have an open foramen ovale. After the first spontaneous inhalation, the pulmonary circulation of blood flow is turned on (it begins to fully function). Over time, the child's open oval window should heal. This occurs due to higher pressure in the left atrium compared to the right. Because of the difference, the valve closes. Then it is completely overgrown with connective tissue. This is how the child’s open oval window disappears.

Causes of the problem

In some cases, the open oval window in the heart does not heal completely or partially. As a result, under certain circumstances, for example, when crying, coughing, tension in the anterior wall of the abdominal cavity, screaming, blood is released into the left chamber from the right.

The reasons that influence the fact that the open oval window in the heart does not heal are not always clear. There is a very widespread opinion that this defect is caused by hereditary predisposition, congenital defects, and prematurity. Causes also include connective tissue dysplasia, adverse effects of external factors, alcohol consumption and maternal smoking during pregnancy. There are also genetic characteristics that cause the valve diameter to be smaller than the opening. This will create an obstacle to its complete closure. This defect may accompany congenital malformations of the tricuspid or mitral valve.

Risk factors

The oval window in the heart can open in adulthood. For example, high physical activity is a risk factor for athletes. This especially applies to weightlifters, wrestlers, and gymnasts. The problem of an open window in the heart is also very relevant for divers and divers. Since they dive to significant depths quite often, their risk of developing decompression sickness increases 5 times.

The functioning of the oval window can be triggered by increased pressure in the right side of the heart. It, in turn, is caused by a reduction in the pulmonary vascular bed in patients with thrombophlebitis in the lower extremities or in the pelvis with episodes of pulmonary embolism in the past.

Features of hemodynamics

The floor of the fossa ovale on the inner left side of the wall of the right chamber is where the patent foramen ovale is located. Dimensions (the average is 4.5 mm) may vary. In some cases they reach 19 mm. As a rule, the hole has a slit-like shape. An open window, unlike a defect in the interatrial septum, differs in its valve structure. It ensures inconsistency of communication between the chambers, the possibility of blood ejection exclusively in one direction (from a small to a large circle).

Experts have mixed opinions about the clinical significance of the hole. An open window may not provoke hemodynamic disturbances and not negatively affect the condition of patients due to the presence of a valve that prevents the flow of blood from left to right, and its small size. Most people with this defect are unaware of its presence.

Detection of a patent window in patients with primary type pulmonary hypertension usually has a favorable prognosis in terms of life expectancy. However, when the pressure is exceeded, a right-to-left shunt periodically occurs. When a certain volume of blood is passed in the opposite direction, hypoxemia develops, a transient disorder of cerebral blood supply (TIA). As a result, the risk of life-threatening consequences increases. In particular, complications such as ischemic stroke, paradoxical embolism, renal and myocardial infarction may develop.

Symptoms

In general, an open window is not characterized by any external manifestations. As a rule, this phenomenon occurs latently, in rare cases accompanied by very scant symptoms.

Characteristic signs

Indirect manifestations of the functioning of an open window include severe pallor or cyanosis of the skin in the area of the nasolabial triangle or lips against the background of physical stress, a predisposition to the occurrence of frequent colds and inflammatory bronchopulmonary pathologies, and delayed physical development. The latter means insufficient weight gain, poor appetite, etc. Also, the presence of an open foramen ovale is indicated by poor endurance during physical activity in combination with symptoms of respiratory failure (tachycardia and shortness of breath), sudden fainting, and signs of cerebrovascular accident. The latter is especially important for young patients, people with varicose veins, thrombophlebitis in the pelvis and lower extremities.

People with an open window often experience headaches and migraines. Often, such conditions are accompanied by postural hypoxemia syndrome, in which shortness of breath develops and oxygen saturation of arterial blood decreases in a standing position. Relief occurs when moving to a horizontal position.

In practice, complications of an open window are quite rarely observed. With paradoxical embolism (it aggravates the pathology) of cerebral vessels, a characteristic feature is the occurrence of neurological symptoms at a young age of the patient.

Diagnostics

The examination is carried out using several methods. Diagnostics includes ECG, ultrasound of the heart. An open oval window is examined using cavity probing and radiography. If there is a defect, changes are observed on the electrocardiogram, which indicate an increase in the load on the right region of the organ in question.

In older patients, when the window is open, radiographic signs of increased blood volume in the pulmonary vascular bed and enlargement in the right heart chambers may be detected.

When examining children and adolescents, transthoracic two-dimensional echocardiography is used. It allows you to visually determine the presence and diameter of the oval window, obtain a graphical picture of the movement of the leaflets over time, and also exclude a defect in the interatrial septum. Thanks to Doppler echocardiography in color and graphic mode, it becomes possible to detect turbulent blood flow, speed and approximate volume of the shunt.

To examine older patients, a more informative type of echocardiography is used, performed by the transesophageal method, supplemented by a straining test and bubble contrast. The latter helps to improve the visualization of the open window, allows you to determine the exact dimensions, as well as evaluate the pathological shunt. Probing of the organ is carried out before surgery. This heart study is carried out in specialized cardiac surgery hospitals.

Therapeutic measures

In the absence of adverse symptoms, an open window can be considered normal. For patients with an active hole in the presence of cases of transient ischemic attack or a history of stroke, systemic therapy with disaggregants and anticoagulants (such as Aspirin, Warfarin, and others) is recommended to prevent the occurrence of thromboembolic complications. As a method of monitoring treatment, the INR (international ratio) is used, which, when the window is open, should be within 2-3 units. The need to eliminate the hole is determined in accordance with the volume of ejected blood and its effect on the activity of the cardiovascular system.

With a small shunt, when the open oval window is 2 mm or in the region of this indicator, surgical intervention, as a rule, is not prescribed. In case of severe pathological backflow of blood, low-traumatic x-ray endovascular occlusion is recommended. The operation is performed under echocardioscopic and x-ray control. During the intervention, a special occluder is used, which, when opened, completely blocks the window.

Forecast

Patients diagnosed with a patent foramen ovale in the heart are recommended to undergo regular examination by a cardiologist and undergo echocardiography. After endovascular occlusion is performed, patients can return to normal activities without any restrictions. During the first six months after surgery, patients are recommended to take antibiotics. Such drugs are used to prevent the occurrence of bacterial endocarditis.

The most effective closure of the oval window by the endovascular method is in patients with platypnea, with a pronounced release of blood flow from right to left. Preventive measures to prevent many congenital pathologies are the following: following a diet and daily routine during pregnancy, visiting a gynecologist, and giving up bad habits.

Finally

Experts recommend regular examinations for patients at risk. These, in particular, include persons with varicose veins, cerebrovascular accidents, thrombophlebitis, chronic pulmonary pathologies, and a predisposition to the development of paradoxical embolism. During pregnancy, a woman should be under close medical supervision and monitor her diet and exercise.