A gap in a child's heart. Foramen ovale in the heart in children: characteristics, causes, diagnosis and treatment methods. Treatment: is surgery necessary?

A small opening between the left and right atria, which forms during fetal development, is known as a patent foramen ovale.

What is special about its formation and does it pose a danger to human life?

The essence of LLC

This problem is normal for a fetus, but in adults it is an anatomical feature of the structure of the heart.

The human heart consists of 4 cavities: two atria and two ventricles, which are closely interconnected through special channels. Between the right and left atria is the interatrial septum.

Its role is to regulate blood flow from the left atrium to the right. There are often cases when this septum is formed incorrectly, forming a hole - an open oval window.

The process of blood circulation in children and adults has some differences: during the development of the fetus in the womb, its lungs do not participate in the respiratory process. In this regard, only 12% of the total blood flow passes through them.

This is necessary to enrich the internal organs of the fetus (brain, liver, etc.) with oxygen, which is contained in the blood passing through them.

The direction of blood in the fetal body is regulated by special messages that are located in its cardiovascular system, for example, arterial and venous blood flows. Patent foramen ovale is also one of these reports. It pumps oxygenated blood from the right atrium to the left, thereby reducing the flow of blood into the fetal lungs.

From the inside of the cavity of the left ventricle, the opening is covered with a small valve. Before the onset of labor, this valve is already fully formed.

After a newborn baby makes its first cry, its lungs open and oxygen and blood flow into them. This causes the valve to close and increase the pressure level in the left atrium.

After some time, the walls of the valve leaflets gradually grow to the walls of the interatrial septum. This process is finally completed during the first year (in rare cases - by 5 years).

It is possible that the valve leaflets are too small, which cannot ensure complete closure of the opening between the atria. It is in this case that we are talking about the development of OO windows.

According to statistics, an open foramen ovale in adults (in 30% of all cases) entails the development of various diseases of the cardiovascular system or pulmonary pathology.

The main reason for this situation is the increased intracardiac blood pressure. Since the development of this problem begins in the prenatal period of fetal development, in adults PFO is considered a heart defect.

Causes

As a result of the patent foramen ovale remaining open or slightly open, during severe coughing, crying, or as a result of abdominal tension, blood is ejected from the right atrium into the left. This is a clear manifestation of the action of an OO window.

To date, experts have not been able to fully understand the exact reasons that lead to the occurrence of this pathology. Among known factors include:

• hereditary factor;
• prematurity;
• congenital defect of the mitral or tricuspid heart valves;
• connective tissue dysplasia;
• negative environmental impact;
• smoking;
• drinking alcoholic beverages during pregnancy.

Experts also include in the risk group people whose bodies are exposed to heavy physical stress, including athletes. You should also not exclude from this group those whose profession involves diving to great depths.

Patients diagnosed with thrombophlebitis of the legs or MT, accompanied by moments of pulmonary embolism, usually suffer from increased pressure on the right side of the heart, and are also at risk for developing a functioning PFO.

If a person is at risk or a pregnant woman has been exposed to the above factors, you should immediately contact a specialist to undergo a comprehensive examination. This can reveal the presence of pathology and prevent heart disease.

Symptoms, dangers and treatment

As a rule, an open oval window is small in size and does not cause any discomfort in patients.

If PFO was not diagnosed and eliminated in childhood, this anomaly can provoke manifestation of such signs:

• fast fatiguability;
• weakness;
• exposure to frequent respiratory infections: cough, sore throat, bronchitis, etc.;
• shortness of breath, which tends to manifest itself not only during heavy physical exertion, but also during moderate exercise;
• dizziness;
• severe headaches;
• migraine;
• frequent fainting conditions.

Unfortunately, it is not always possible to identify the OO window during a routine medical examination. Typically, pathology is discovered only after the patient begins to exhibit complications of this anomaly.

WITH Some of the most common complications include:

• transient type of cerebral circulatory disorder - characterized by short-term disturbances in the functioning of the human brain. The main reason for this is the failure of the blood supply process in the GM. In this case, a person experiences loss of speech, memory, numbness of the upper or lower extremities, and disruption of the activity of certain parts of the body. The maximum duration of manifestation of these symptoms does not exceed a day;
• stroke is a rather severe and dangerous complication of LLC, which consists in the death of some areas of muscle tissue. In this case, the patient exhibits symptoms similar to those seen in a transient disruption of the blood supply to the brain. A distinctive feature of this condition is that the duration of manifestation of these symptoms is much more than 24 hours;
• kidney infarction - manifests itself in the form of death of part of the kidney, which is accompanied by severe pain in the lumbar region, bloody discharge in the urine, a small amount of urine excreted, and an increase in body temperature.

It is also worth noting that a patent foramen ovale is extremely dangerous for people who dive. This is due to the fact that they are at increased risk of developing decompression sickness. In order to obtain permission to dive below 10 meters, such people need to close the LLC.

An open oval window is dangerous due to the possible development of complicating processes. To reduce the risk, you should immediately contact a specialist for a comprehensive examination.

The choice of treatment method for this pathology depends on the size of the oval hole, the presence of complications, as well as concomitant diseases.

The use of drug therapy will not lead to complete closure of the window. For this purpose, the method of surgical catheterization or surgery is used. In most cases, the pathology does not require treatment. Patients with this anomaly live long and fulfilling lives, work and give birth to children.

In order to avoid the development of complications, children diagnosed with a patent foramen ovale should be under the supervision of specialists. As for adult patients, they should also undergo periodic medical examinations.

What is a patent foramen ovale?

A patent foramen ovale (Figure 1) is a small opening between the right and left atria that normally functions in every fetus. This structure acts as a valve that directs blood from the lower half of the fetus's body to the left side of the heart, bypassing the non-functioning lungs. As the lungs expand with the baby's first breaths, the need for this structure disappears, since now all the blood from the body passes through the lungs and only then enters the left atrium. The pressure in the left atrium gradually increases and several months after birth exceeds the pressure in the right atrium, which contributes to the closure of the oval window in most people.

However, the oval window does not heal and remains open in approximately 25% of healthy adults.

Symptoms

An open oval window is an individual feature and does not manifest itself clinically. The oval window is not considered a heart defect. Patients with a patent foramen ovale can lead their usual lifestyle and physical activity.

Patent foramen ovale and stroke

Under certain conditions, when the pressure in the right atrium again begins to exceed the pressure in the left atrium, the oval window again begins to act as a valve, directing blood from the lower half of the body to the left chambers of the heart. If there is stagnation of blood in the venous system (for example, in the veins of the lower extremities or pelvis), blood clots form there. The latter, together with the blood, can pass through the oval window into the left chambers of the heart, then into the brain and cause a stroke (Video 1).

A patent foramen ovale is found in 25% of adults under the age of 55 who have had a STROKE. In most cases, a patent foramen ovale is often combined with thrombosis of the veins of the lower extremities and a sedentary lifestyle.

Diagnostics

All young people who have suffered a stroke should undergo routine transthoracic and transesophageal ultrasound of the heart and Doppler craniography of cerebral vessels. An ultrasound of the heart confirms or excludes the presence of an oval window, its anatomy (the presence of an aneurysm of the interatrial septum), and shows, using various tests, the direction of blood flow at the level of the oval window.

If, during echocardiography, when the patient strains (Valsalva maneuver), the direction of blood flow from the right atrium to the left is observed, this confirms the fact that the cause of the stroke was a patent foramen ovale.

Ultrasound Dopplerography of the vessels of the head (Doppler craniography) confirms or excludes the entry of small blood clots from the veins of the lower extremities into the vessels of the brain through the oval window.

The presence of an aneurysm of the interatrial septum in combination with a patent foramen ovale increases the likelihood of developing a stroke, since the aneurysm contributes to greater mobility of the septum, which means that more blood clots will be directed through the oval window into the vessels of the brain.

Should a patent foramen ovale be closed?

If the foramen ovale is found by chance during a routine cardiac ultrasound, there is no need to close it. The oval window does not lead to an increase in heart size. It is possible to distinguish a foramen ovale from a small atrial septal defect only with the help of transesophageal ultrasound.

THE OVAL WINDOW SHOULD BE CLOSURED ONLY IF THE PERSON HAS SUFFERED A STROKE. It is closed if the presence of a right-to-left direction of blood flow is confirmed during the Valsalva maneuver.

The oval window is closed endovascularly using a special device - an occluder (Fig. 2, 3).

The technique and device are similar to closure of an atrial septal defect (Video 2).

Closing the patent foramen ovale in young people who have had a stroke SIGNIFICANTLY REDUCES THE RISK OF REPEATED STROKES (Video 3).

Lifestyle in patients with a patent oval window.

If you are a driver and you know that you have a patent foramen ovale, it is recommended that you stop every 2 hours for a short walk. An active lifestyle reduces the risk of blood stagnation and thrombus formation in the veins of the lower extremities, and therefore reduces the risk of stroke in patients with a patent foramen ovale.

Video 1: A blood clot travels from the right side of the heart to the left and causes a stroke

Video 2: In this colorful animation you can see how the LLC is closed with an occluder.

Video 3: LLC closed with an occluder (X-ray video).

How is the treatment done?

Myths and reality about endovascular surgery
congenital heart defects

Currently, X-ray endovascular surgery is attracting more and more attention from almost all media, including print media, the Internet and television. Every day we are confronted with a massive flow of information on various aspects of this modern field of medicine. Every day they write and talk about it, but, unfortunately, not everything and not always objectively. There are many erroneous statements, rumors or even myths that need to be corrected with factual information.

Myth 1. This is a very new, almost experimental field of cardiovascular surgery.

This is wrong! Endovascular surgery has a rich history and has long been widely used in medical practice. Cardiac catheterization was first performed in 1929 by R. Forsmann (Germany), for which he received the Nobel Prize in 1956. In 1964, the first balloon angioplasty was performed and since then endovascular surgery has ceased to be a purely diagnostic area of ​​medicine. Further discoveries and inventions of devices followed one after another: 1975 - spirals, 1976 - occluders, 1979 - emboli, 1986 - coronary stents, 1994 - stents for large vessels, 2005 - endovascular heart valves! To date, all of the above devices have evolved to more advanced analogues. The most common occluder in the world has become the Amplatzer occluder - more than half a million implantations since 1995. At the Amosov Institute, Amplatzer occluders have been installing their analogues since 2003. The trend in the world is that diagnostics have moved from the cath lab to echocardiography and computed tomography rooms, and the treatment of heart defects has moved from the operating room to the cath lab. In developed countries of the world (USA, Canada, Australia, Europe), ductus botellus, septal defects, and coarctation of the aorta are practically not operated on surgically. Our institute takes into account all modern global trends when treating patients.

Myth 2. Devices used to treat defects (occluders, coils, stents) are foreign bodies and can be rejected.

All these devices are made of modern high-tech biocompatible materials that do not cause rejection reactions. Six months after the operation, these devices are completely covered with endothelium (they grow with their own cells) and do not differ from the inner surface of the heart. All devices are non-magnetic; after their implantation, the patient can undergo an MRI. They do not beep at metal detectors at airports, shopping malls, etc.

Myth 3. Occluders move (fly away).

Indeed, in our and world practice such cases occur, but their frequency is about 1%. The complication is unpleasant, but not critical. There has not been a single case in the world where a displaced occluder would have led to death. As a rule, such an occluder is removed endovascularly and reinstalled or replaced with a larger one. The greatest number of displacements occurs in the first hours or days after surgery, when the patient is still in the clinic. Further, the probability of this decreases sharply; distant displacements are casuistic.

Myth 4: Atrial septal defects with missing or thinned edges are not amenable to endovascular closure.

The absence of the aortic edge of the septum is not a contraindication to occluder placement. The same applies to a thinned or aneurysmal septum. Remember that conventional (transthoracic) echocardiography does not provide a complete picture of the defect. Even if a diagnosis of absence of a margin is made, this does not mean that it is not there. The clear anatomy of the defect can only be judged after transesophageal echocardiography, which is the gold standard for selecting patients for endovascular treatment.

Myth 5. Occluders require replacement over time.

The device does not need to be replaced either as the patient grows or over time. The occluder grows into the septum within 6 months and creates the basis for its further growth. In the case of vascular stenting, it is possible to endovascularly increase the lumen of the stent with vessel growth without replacing the implant.

Myth 6. It's expensive...

Endovascular surgery is high technology, which really costs more than conventional operations. In some cases, the patient buys the device for implantation, but there is a waiting list for free implants, which are purchased by the institute. In addition, we cooperate with numerous relief funds that, in a relatively short time, raise funds to purchase devices for children. In most cases, there is no urgency in the operation, and patients have enough time to raise funds for the implant, wait their turn, or find a sponsor. Therefore, if a patient wishes to undergo endovascular surgery, there are currently no barriers to this.

FAQ

The average hospital stay is 3-4 days. As a rule, on the day of admission in the morning you undergo an examination, including a clinical and biochemical blood test (you need to arrive on an empty stomach), an X-ray, an ECG, an ultrasound examination of the heart and a consultation with a cardiologist and cardiac surgeon. If all indicators are normal, the next day an operation is performed to eliminate the defect. On the third day, we conduct control tests and discharge you.

To be admitted to our hospital, you will need a passport or a child’s birth certificate.

If the patient is a child, you need a certificate of sanitary and epidemiological conditions (stating that the child has not recently had contact with infected patients), which you will receive at the clinic at your place of residence.

It is advisable to have previous advisory reports, an ECG and a chest x-ray with you.

A referral from a local cardiologist is NOT REQUIRED. You can come for a consultation and subsequent treatment by self-referral. If you are over 30 years old or have experienced interruptions in your heart function, it is advisable to conduct Holter monitoring at your place of residence. Such a study can be carried out here, but this will increase your time in hospital by 1-2 days.

If you suffer from chronic gastritis, gastric or duodenal ulcers, you need to undergo fibrogastroduodenoscopy. If the disease is confirmed, you need to undergo treatment at your place of residence. Such a study can be carried out here, but this will increase your time in hospital by 1-2 days in the absence of ulcers and erosions.

All adult patients undergo surgery under local anesthesia. The patient can observe the progress of the operation and communicate with the staff. The exception is patients with an atrial septal defect, who require transesophageal ultrasound guidance during surgery and, for patient comfort, the operation is performed in a state of medicated sleep. All endovascular operations in children and hypochondriac patients are performed under general anesthesia.

It is necessary to limit vigorous physical activity for 6 months. Prevention of respiratory infections, tonsillitis, and caries is necessary. If the disease begins to develop, antibacterial drugs should be included in the treatment regimen after consultation with a doctor. During the first month after surgery, it is also necessary to limit sexual activity.

In a healthy person, the heart consists of four chambers, two of which are separated by a thickened septum that prevents blood from flowing from the left to the right. Sometimes the connecting fragment is modified and turns into a gap, causing defectiveness. Foramen ovale in the heart is a congenital disease in a newborn child, which is characterized by the formation of an opening between the right and left atrium. Pathology can be caused by a hereditary factor and, in very rare cases, chronic diseases that disrupt the proper flow of blood through the chambers of the heart.

In children under the age of five, the presence of a gap in the heart is normal, but if the anomaly develops at an older age, then it is necessary to be regularly examined by a doctor, because the disease has serious complications.

An open foramen ovale in the heart in children is usually closed by a valve immediately after birth due to an increase in pressure in the first atrium, and subsequently fuses with the septal wall. But in some cases, the valve is too small to close the gap, and then the pathology becomes aggravating.

The causes of an open foramen ovale in the heart in a 6-7 year old child are determined by several factors:

• bad ecology;
• heredity;
• bad habits during pregnancy;
• poor nutrition during gestation;
• use of drugs prohibited during pregnancy;
• stress.

In rare cases, pathology develops against the background of disorders that increase tension in the right atrium and, thereby, open the valve to the left. Such processes include persistent lung diseases, other heart disorders, as well as gestation and childbirth.

An open foramen ovale in the heart in a child under five years of age does not, at most, cause concern on the part of the doctor, but an examination by a cardiologist is mandatory at least once a year. If this requirement is not taken into account, the disease may be diagnosed at an older age with acquired abnormalities in the functioning of the cardiovascular system and other aggravating consequences.

An open foramen ovale in the heart in an adult is a consequence of neglect of treatment methods when identifying the disease or lack of diagnosis throughout life caused by incompetence of research methods. Sometimes the defect is discovered when examining others, when dysfunction of the interatrial septum is detected and, accordingly, the valve opens.

An open foramen ovale in the heart has mild or pronounced symptoms depending on the size of the hole. With a gap of no more than 5-7 mm, no signs are observed, with the exception of bluish lips () after physical exertion and paleness of the face.

Symptoms of an open oval face actively appear when the gap between the right and left atrium is more than 7 - 10 mm:

• regular blueness of the lips and area around the mouth, regardless of previous actions;
• retardation in physical development;
• violation of movement coordination;
• dyspnea;
• unexpected fainting;
• migraines and other types of headaches;
• frequent colds;
• the appearance of blood clots;
• VSD - ;
• numbness of the limbs;
• increase in blood volume in the lungs.

The acquisition of a pale blue tint on the lips and in the mouth area is the main indicator of pathology, especially if changes in the skin appear after holding your breath under water, severe physical exertion, as well as other heart and lung diseases.

Diagnostics

If there are characteristic signs of pathology, additional studies are carried out to determine the size of the gap and the risks of complications.

Diagnosis of an open oval face in the heart is carried out only by instrumental methods:

• Ultrasound () of the heart through the esophagus, which allows detailed identification of abnormalities in the structure of the heart;
• probing the cavities of the heart to examine the interatrial fissure and assess the patient’s condition for surgical interventions;
• electrocardiogram to obtain information about the interaction of all parts of the heart;
• to study the blood flow of vessels near the oval window;
• X-ray showing enlarged atria on the picture if there is a large hole between them;
• duplex scanning, with which you can find out about the patency of the veins of the lower extremities and identify the presence of thrombosis.

The probing method has a number of contraindications and cannot be prescribed to patients with increased blood clotting, renal failure, thrombosis and embolism. If the method is incompatible with the patient’s health condition, another type of examination is used - ultrasound of the heart.

A routine examination of the patient cannot indicate pathology, so doctors immediately resort to a visual examination of the damaged segment.

If the size of the gap is small and there are no symptoms that interfere with the quality of life, medication and hospital treatment are not prescribed.

• increase the immune protective functions of the body through hardening;
• take a contrast shower to stimulate the heart;
• organize walks in the fresh air;
• visit at least once a year;
• do not disturb the biological clock;
• eat only healthy foods, excluding fried meat, canned drinks and fast food from the supermarket;
• engage in physical therapy.

An open foramen ovale in the heart can affect the cardiovascular system, causing organ conduction disturbances and sudden surges in pressure.

In such cases, drug treatment is mandatory to stabilize the heart:

• preparations containing magnesium;
• vitamins and medications that improve interaction between the chambers of the heart;
• tablets that stimulate the production of energy in the pinpoint regions of the heart.

If the opening is large and blood flow is formed in the left atrium, surgical intervention is indicated, in anticipation of which thrombosis is prevented. Some time before the operation, the patient is given elastic bandages on the lower limbs and prescribed medications that inhibit blood clotting.

During surgery, a patch is inserted through the femoral vein using a catheter into the right atrium. When ingested, it opens up in the shape of an umbrella and covers the surface of the hole. Within a month, the patch is resorbed and activates the formation of connective tissue at the site of the gap. Thus, the open foramen ovale in the heart closes. The operation is recommended only in complex cases, when the size of the gap portends complications and is considered a heart defect.

The treatment method using a patch is an innovation in Russian medicine, but is already widely applicable. However, if such an intervention is not available due to external circumstances, then an occluding device is used during surgery, which is inserted according to the same principles as a patch.

The occluder inside the body opens in the shape of an umbrella and completely covers the oval window. The operation is used extremely rarely, because inflammation of the tissue around the occluder may occur. Preference is given to surgical interventions using a patch.

If blood clots are detected in the veins of the legs, treatment of an open oval window is determined by constant observation by a phlebologist and monitoring of blood clotting.

Complications

If the doctor's recommendations are not followed, even a slight gap in the chambers of the heart can lead to serious illnesses leading to sudden death. To avoid aggravating consequences, you need to avoid excessive physical activity, including diving, be constantly monitored by a hematologist for the appearance of blood clots, and visit a cardiologist at least once a year.

Among the complications of congenital pathology are:

• decompression sickness, which destroys the walls of cells and blood vessels and leads to paralysis and death;
• paradoxical embolism, during which a blood clot breaks off, clogging vital arteries and creating a threat of death if it is large;
• septic endocarditis, affecting the cardiac channels and causing death;
• stroke, which occurs when a blood clot forms in an artery of the brain;
• myocardial infarction caused by blockage of the coronary arteries of the heart by a blood clot;
• kidney infarction due to blockage of the corresponding vessels;
• a violation of cerebral blood supply, in which motor and auditory functions are damaged and memory impairment occurs.

The patient is obliged to warn the attending physician about the congenital pathology so that the risk of complications can be reduced or the existing symptoms can begin to be eliminated.

Forecast

If you follow the doctor’s requirements and see a cardiologist once a year, the prognosis for an open foramen ovale in the heart will be quite favorable. You can be confident in longevity and not feel painful symptoms if you don’t overwork yourself in physical exercise, don’t dive under water and try to fly less on an airplane. Any actions that cause increased stress on the circulatory and respiratory systems lead to complications.

Patients who have undergone surgery due to a large oval window get rid of the defect forever and do not put their body at risk during surgery. After the operation, they lead a full life and after some time they can forget about previous lifestyle restrictions. However, if the size of the gap does not exceed normal limits, the operation is not recommended, because the pathology, to a greater extent, is in the nature of structural features of the heart, and not a serious illness. The patient's life is threatened only by complications that develop against the background of pathology.

Risk group

There are a number of professions that can have a fatal impact on the health of people with a patent foramen ovale in the heart.

It is sad that untimely diagnosis of pathology or a negligent attitude towards one’s own well-being leads to death. And all because with strong immersion or ascent, blood clots can form in the artery, blocking the vessel and foreshadowing instant death.

People with a patent foramen ovale in the heart should exclude the following professions and even one-time hobbies from their lives:

• pilot;
• astronaut;
• diver;
• diver;
• scuba diver;
• driver;
• driver;
• submarine crew;
• caisson workers;
• army employee.

When serving in the armed forces, conscripts are required to perform vigorous physical activity every day. Since the number of deaths in the army has increased, and the main reason for this is heart disease, medical examination has begun to carefully examine each conscript. When diagnosed with an open foramen ovale in the heart, they become unfit for service and are sent for treatment to avoid blood clot detachment and blockage of blood vessels, which pose a threat to life.

Heart pathology caused by the formation of an open oval window is not a death sentence, but requires constant monitoring by a doctor and unquestioning adherence to the treatment regimen.

If you take care of yourself, do not overexert yourself, exclude active sports and eat properly in the presence of such an anomaly, then you can feel like a completely healthy person and live a long life.

If you take risks, knowing about your disease, and dive under water, fly on an airplane, or experience grueling physical activity, then you can predict with an 80% probability the development of an embolism, which will result in disability or death.

All questions that relate to the direct structure of the child’s heart raise many questions and fears in all parents, since this organ is the basis of life, along with the brain, and if there is even a small defect in it, it greatly frightens mom and dad. After an ultrasound of the heart, the doctor suddenly writes on the chart “an open foramen ovale in the heart,” and all parents think that the baby has a heart defect, they panic too much and start running to specialists. Today, approximately 70% of children have such a conclusion in the first anxious month of life, but what kind of oval window is this, and why should it be open?

Baby's blood circulation

During pregnancy, the heart and vascular systems develop early, but the heart is formed in the body already at three weeks. Of course, it is still being formed and developing, but it copes with its main functions. During the prenatal tender period, the baby's blood circulation is special - the lungs are completely turned off. In order to optimally provide the growing body and brain with oxygen, a special structure of the heart is needed.

Blood enters the small heart in a roundabout way, bypassing the pulmonary circle, so there are several additional openings in the children's heart - the ductus ductus, as well as a small open foramen ovale. Why is it open? Through the duct, the blood enters directly into the heart, bypasses the pulmonary aorta and blood vessels, and through the oval window it moves from the right to the left atrium. If this hole, thought out by nature, had not been provided and it had not been open even by some 2-3 mm, the right parts of the heart would have been overloaded and the child would not have been able to live in the womb.

At birth, a child’s blood circulation changes dramatically; the ductus ductus, as well as the open foramen ovale, lose their original relevance and therefore must close. This occurs due to the opening of the lungs and breathing. Due to changes in the left atrium, the patent foramen ovale is closed by a valve.

This usually occurs in newborns on the first day of life. The oval window closes, and a full-fledged permanent interatrial septum begins to form. Of course, this process can take quite a long time, but more often the open foramen ovale in tiny newborns closes immediately.

Oval open window: reasons for formation

Underdevelopment of the valve, as well as an open oval window, occurs in premature newborns. The causes of this phenomenon are considered to be a noticeable disturbance throughout pregnancy - threats of miscarriage, fetal hypoxia or toxicosis. Also, the risk of getting a patent oval window is increased in women who smoke and drink alcohol while carrying a child. Also, the window may be open due to unfavorable ecology, stress during pregnancy, or the influence of heredity.

As a result of all the indicated processes, the normal natural development of the valve in the area of ​​the oval window itself is disrupted; it simply does not have time to grow to the required size.

However, an open oval window can also occur with more acute and serious problems than a simple functional defect. Sometimes, with ailments that load the right chambers of the heart, the window may not close to alleviate the child’s condition.

Manifestation of such a state

With a small defect size of 2-3 mm, this is an ordinary child, there are no defects in this situation, and therefore there will be no manifestations. A patent foramen ovale is detected by ultrasound examination, which is required for all children under one year of age. However, if the defect is significantly larger than 2-3 mm, there are certain signs that help the doctor detect the problem:

• Cyanosis of the nasolabial triangle or lips in a child with strong crying, screaming, or activity.
• Frequent diseases include colds, pneumonia and bronchitis.
• A patent foramen ovale is immediately manifested by listening to a heart murmur.
• Certain slowdowns in the rate of physical or psychological development may certainly indicate that the oval window is open even by 2-3 mm.
• The fact that the oval window is open can be indicated by attacks of loss of consciousness, the manifestation of various symptoms of a violation of the entire cerebral circulation.
• Inability to perform increased physical activity, fatigue, and a feeling of shortness of breath also indicate that the window is not normal.

The last three symptoms occur when the defect significantly exceeds 2-3 mm. If the doctor suspects your child has a patent foramen ovale, he will refer him for a consultation with an experienced cardiologist and an ultrasound scan. It is there that they will verify its size: 2-3 mm, when anxiety is unnecessary, or more, when it is necessary to correct the disease with treatment.

Oval open window of a child: what to do?

If an oval open window has been detected in a baby, the further actions of the parents, cardiologist and pediatrician must be decided. If the window is open only 2-3 mm, it should not cause concern, since such a hole quickly closes in a couple of months. You just need to see a doctor and sometimes undergo an ultrasound.

If the window is open significantly more than 2-3 mm, you will need to go for an ultrasound every six months to determine the size of the defect. If the open hole becomes smaller, the specialist will suggest waiting and doing nothing - there is a high probability of spontaneous healing of this defect.

If the open foramen ovale is more than 7 or even 10 mm, serious abnormalities that are typical of heart defects may appear. Such a hole will be called gaping. The child needs to be consulted by a good cardiac surgeon and the issue of urgent surgery with a certain correction of the septum must be decided.

The greatest danger of the disease is the possibility of active development of acute paradoxical embolism, which affects the vessels of the head. But this happens quite rarely.

All photographic materials are taken from the site Google.Images.ru

A patent foramen ovale is not a heart defect. Every child is born with it. When the baby takes his first breath, his blood circulation will begin to work normally, and the need for it will disappear. The window disappears when the pressure in the left atrium becomes higher than in the right. Usually, the valve is overgrown with connective tissue, after which the LLC disappears.

If the hole is not completely closed or is not closed at all, blood is discharged from the right chamber to the left. That’s when they talk about the diagnosis of “patent foramen ovale” in an infant. According to statistics, more than 40% of adults suffer from it. Is it really that dangerous? Let's take a closer look.

Features of the disease

Depending on age, the disease may differ. Thus, in infants, a window that is not completely closed cannot open due to physical stress, so PFO can only be caused by pathologies.

Symptoms also differ at different ages.

• For example, infants do not gain weight well, become irritable, and may experience cyanosis.
• Older children experience developmental delays and restlessness.
• OOO in adolescence is characterized by low endurance, fatigue, headaches and dizziness.

If the open oval window has closed, then it will no longer be able to open.

You can see what an open oval window looks like in the following video:

Classification of open oval window

The LLC is located on the inner side of the left wall of the right atrium, namely at the bottom of the fossa ovale. Most often it has a small size (up to 2.5 mm) and an elongated shape, similar to a slit. The oval window is classified by size, which can be:

1. small;
2. average;
3. big;

A large window can reach 20 mm, then they speak of complete non-closure, which is a wide round hole.

Causes

The causes of the disease are not fully understood. Some factors can lead to the appearance of an open oval window in an infant, such as:

1. hereditary predisposition;
2. prematurity;
3. heart defects;
4. connective tissue dysplasia;
5. negative impact of the external environment;
6. use of drugs, tobacco and alcohol during pregnancy;
7. genetic abnormalities;

There is a risk of the oval window opening. Thus, in athletes who are fond of weightlifting, wrestling and similar sports, the oval window may open due to heavy physical exertion. The following are also at risk:

1. divers and divers;
2. patients with thrombophlebitis;
3. patients with pulmonary embolism;

It should be noted that the opening of the oval window is observed in people with an open foramen. The reasons for non-union are not fully understood.

Symptoms

In most cases, LLC occurs without specific signs with very scanty symptoms. Indirect signs of the disease include a whole group of symptoms such as:

1. pale skin;
2. cyanosis in the lip area during physical load;
3. delayed physical development in children;
4. fainting;
5. dizziness;
6. headaches;
7. shortness of breath;
8. low endurance;

However, these symptoms are indirect and cannot be used to diagnose the disease.

Diagnostics

To diagnose an open oval window, it is necessary to undergo hardware examinations, for which a doctor gives a referral. The doctor collects an anamnesis of complaints and symptoms, evaluates the patient’s nutrition, conducts a physical examination and, based on the results of the studies, prescribes:

• General tests of blood and urine to assess the condition and identify concomitant diseases.
• Biochemical analysis of blood to determine the level of cholesterol, triglycerides and sugar.
• Coagulogram to assess the likelihood of blood clots.
• EchoG with Dopplerography to detect the valve of the LLC, cardiac anomalies.
• ECG, which reveals heart pathologies.
• Chest X-ray to determine the size of the heart muscle.

It is also possible to consult with other doctors, for example, a therapist. We’ll talk about the treatment of an open oval window next.

Treatment

If the patient does not have significant disturbances in the functioning of the heart, then treatment of PFO can be limited to therapeutic methods and medications. In case of severe pathologies, endovascular treatment may be required.

In a therapeutic way

• Limit physical activity. loads.
• Eat a balanced diet, 4-5 meals a day. Pay special attention to vegetables and herbs.
• Maintain a schedule of work and rest, do not overexert yourself.

It is also important to maintain proper sleep patterns and not overtire the body.

Medication

Along with therapeutic measures, patients are also prescribed medications if signs of malaise appear:

• Anticoagulants, for example Warfarin. Designed to prevent thrombosis and thromboembolism.
• Antiplatelet agents or antiplatelet drugs, for example, Aspirin for prevention, or.

Drugs with other effects may also be prescribed depending on concomitant diseases.

Endovascular procedure

Surgery is no longer performed because it has been completely replaced by the endovascular procedure.

During endovascular treatment, a catheter is inserted into the artery. An occluder is installed at the end of the catheter, which occludes the oval window when inserted.

Disease prevention

There is no specific prevention of LLC. To prevent opening an uncovered window, it is important:

• Maintain balanced physical activity and do not overexert yourself.
• Treat emerging diseases in a timely manner and prevent their complications.

Drivers and divers must avoid excessive loads and strictly adhere to safety precautions when working.

Read on to find out whether you are recruited into the army if you have an open foramen ovale.

Do they take you into the army?

An open foramen ovale fits Article 42, according to which the patient is partially or completely exempt from military service with the following categories:

• B, of limited use if there is a disease with blood discharge. The conscript is unfit for service in peacetime.
• B, suitable with minor restrictions if the disease is without blood discharge.

However, you need to remember that now there is a strict selection process for the army, and often people with any form of LLC are exempt from service. The final decision will be made by the draft committee.

If there is a risk called an open oval window during pregnancy, you should take care of prevention.

Prevention during pregnancy

There are precautions that a pregnant woman must take to reduce the risk of the disease in her unborn child, for example:

• Rejection of bad habits.
• Maintaining proper nutrition. It is necessary to limit the consumption of fried, smoked and spicy foods, and pay special attention to foods with a high fiber content, that is, vegetables, herbs, beans, etc.
• Avoid contact with strong ionizing radiation.
• Avoiding contact with caustic chemicals. things, for example, varnishes, paints, liquid medications.
• Avoidance or prompt treatment of infectious diseases, especially rubella.

In general principles, prevention comes down to following the principles of a healthy lifestyle.

Complications

The patent foramen ovale itself often leads to the formation of blood clots in the heart. Due to thrombus formation, there is a high risk of:

• which leads to brain damage.
• Myocardial infarction, leading to damage to the heart muscle tissue.
• Kidney infarction, leading to death of kidney tissue.
• A transient cerebrovascular accident that temporarily disrupts brain function.

You need to understand that insufficient blood circulation affects all human organs, and therefore can lead to other pathologies.

Forecast

With proper treatment, the prognosis for patients is positive. After surgery, it is recommended to take medications prescribed by your doctor and maintain a healthy lifestyle to maximize the benefits. It is also recommended to regularly visit a cardiologist and undergo echocardiography.