There was an open foramen ovale. Open foramen ovale in a newborn: what is it?

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

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

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

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

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

Symptoms

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, etc.

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 bronchopulmonary system;
• fainting (in severe cases).

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

Possible complications

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

Diagnostics

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

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

Treatment

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

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

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

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

Forecasts

In most cases, an open foramen ovale in newborns and children under two years of age does not cause serious complications and does not bother the child. In most children, it completely heals by the age of five and does not in any way affect further physical and social activities. For patients with a patent foramen ovale without serious hemodynamic disturbances, cardiologists recommend excluding extreme sports and choosing professions that are associated with excessive stress on the respiratory and cardiovascular systems (divers, pilots, astronauts).

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

What is the “oval window” in the heart?

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

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

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

But first things first:

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

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

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

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

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

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

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

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

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

Types of oval window according to the degree of nonfusion

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

How does the disease manifest?

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

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

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

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

Adults with pathology may also experience bluish lips with:

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

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

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

Diagnostic methods

Echocardiography is the gold standard and the most informative method diagnosis of this pathology. The following signs are usually detected:

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

The most informative is an ultrasound examination of the heart, performed not through the chest, but the so-called transesophageal echocardiography. 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 x-ray of the organs are possible chest(slight enlargement of the atria).

How dangerous is the pathology?

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

Methods of treatment and prevention of complications

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

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

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

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

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

Surgery

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

Currently, endovascular surgery has become widespread.

The essence of the intervention is that a thin catheter is installed through the femoral vein, which is passed through the vascular network to the right atrium. The movement of the catheter is monitored using an X-ray machine, as well as an ultrasound sensor installed through the esophagus. When the area of ​​the oval window is reached, so-called occluders (or grafts) are inserted through the catheter, which are a “patch” that covers the gaping hole. The only drawback of the method is that occluders can cause 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 hole in the septum, it dissolves within 30 days and the oval window is replaced own tissues body. This technique is highly effective and has already become widespread.

Disease prognosis

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

Pregnancy and childbirth in women with the defect

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

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

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

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

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

conclusions

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

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

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

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

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

In what cases is this normal?

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

Sometimes the depression closes on its own in a child who has not yet been born, which provokes right ventricular failure and sudden death 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 ejected venous blood through the depression, the triangular area under the baby’s nose turns blue; this symptom guarantees a functioning oval window. It should close completely by the age of five; the duration of the process depends on the characteristics of the body and manifests itself differently in each child. Usually, the closure of the oval does not occur immediately; ideally, the valve grows to the edges of the recess gradually. In certain cases, it closes after a short period of time; in others, the process can last several years.

Symptoms of pathology

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

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

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

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

Main factors

The reasons for the presence of a patent foramen ovale of 2 mm or larger in the heart vary and are influenced by physiological characteristics the body of each individual person. On this moment 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.

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. Valve underdevelopment is provoked by poor ecology and stressful conditions, 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 tissue damage connecting type, congenital defects of the heart or valves can lead to the opening of windows in children at an older age during development. If a child plays sports, he is at risk of developing such a defect, since playing sports seriously affects health. Since the physical loads in gymnastics, athletics or other sports activities are serious, this provokes the appearance of a window.

Signs depending on age

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

Symptoms of 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;
• heart murmurs heard during an appointment with a cardiologist.

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

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

Diagnostic methods

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

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

Treatment measures

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

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

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 ultrasonic sensor, which pass through the esophagus. Then occluders are passed through such catheters, which cover the hole well. This technique also has disadvantages, since occluders can provoke inflammatory processes in the tissues of the heart. There are also additional method solution to the problem, which is a special patch inserted through a catheter, which then opens into the atrium. It regenerates tissue well and dissolves on its own within thirty days.

Preventing complications

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

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

Open foramen ovale in a newborn: what is it?

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

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

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

Causes

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

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

Symptoms

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

Normally, the size of the oval window in a newborn does not exceed the size of a pinhead and is securely covered with a valve that prevents the discharge of blood from the pulmonary circulation to the large one. With an open 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.”

Possible complications

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

Diagnostics

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

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

Treatment

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

Drug therapy can 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, drugs for additional nutrition of the myocardium (Panangin, Magne B6, Elcar, Ubiquinone) and antiplatelet agents (Warfarin).

The need to eliminate a patent window in newborns is determined by the volume of blood discharged into the left atrium and its effect on hemodynamics. In case of minor circulatory disorders and the absence of concomitant congenital heart defects, surgical treatment is not required.

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

Article publication date: 02/10/2017

Article updated date: 12/18/2018

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

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

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

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

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

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

What is a patent oval window for?

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

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

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

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

Oval window – important structure, providing blood circulation to the fetus during the intrauterine period. But after the birth of a child, it should not function and gradually overgrows.

Possible development of pathology

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

When this happens - the process of overgrowing

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

Children of the first year of life

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

Children of the second year of life

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

Adults

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

Six reasons for the problem

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

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

Pathological signs and symptoms

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

About 70% of people with an open canal do not have any complaints. It's connected with small in size defect (less than 3–4 mm).

How to diagnose the problem

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

Treatment

When deciding on the need for treatment and choosing the optimal method, two factors are taken into account:

1. Are there any symptoms or complications:

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

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

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

Forecast

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

A patent foramen ovale is a pathology of the heart, namely the presence of a gap in the septum between the left and right atria, which is necessary for the baby’s intrauterine life. After birth, this window should close completely with a valve and become overgrown.

As practice shows, this pathology is present in ½ of the population who live a normal life and are not aware of the presence of the disease.

Oval window - classification of cardiac pathology

Pathology can be classified according to dimensions, which are measured in millimeters:

1. With sizes ranging from 5 to 7 mm, the diagnosis may sound hemodynamically insignificant. An open window can manifest itself in this case only during strong physical exertion.
2. If the size of the oval window ranges from 7 to 10 millimeters, then the diagnosis may sound like a “gaping oval window” and is symptomatically not much different from congenital heart disease (atrial septal defect).

Reasons for a window not closing

There are a number of reasons that can lead to the development of this pathology:

• hereditary factor, most often observed in the first line of kinship;
• bad habits of the mother during pregnancy (alcohol and smoking);
• the presence of a bad environmental factor during pregnancy;
• absence healthy eating mothers during pregnancy;
• a woman expecting a child is in constant stress and depression;
• Availability toxic poisoning during pregnancy (including medications);
• also the presence of early delivery; in most cases, it is premature babies who suffer from this pathology.

How should it close?

For all medical indications, closing the oval window with a special valve when normal development The birth of a baby occurs in the first seconds of his independent life, with his first breath.

With an increase in pressure in the blood vessels of the lungs, the functionality of the oval window becomes unclaimed.

The valve should completely adhere to the septum by the end of the baby's first year of life. But there are also cases of completion of this process by the 5th year of a child’s life.

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Problems in an adult

An adult whose age does not exceed 40 years, in the absence of diseases of cardio-vascular system the presence of an open oval window in the heart area does not interfere with leading a full lifestyle.

Patent foramen ovale in the heart in an adult whose age category has crossed the threshold of 40 years, when diseases related to the heart and blood vessels occur, it can complicate the treatment of the disease.

If a doctor suspects this heart pathology, the patient should be referred for diagnosis using ECG, radiography and echo-CG.

The presence of the disease in athletes

The life of an athlete is closely connected with physical activity of increased severity.

When completing tasks this pathology may be manifested by the following symptoms:

• the appearance of shortness of breath;
• expressed in the athlete’s low activity, which is facilitated by his rapid fatigue;
• the appearance of fainting conditions;
• presence of severe headaches, migraines;
• manifestation of signs of suffocation (lack of air).

If these symptoms are detected, you must immediately consult a doctor to full examination and prescribing medication.

One of the methods is surgical intervention. Possibility to stay in big sport Only a doctor should decide based on the diagnostic results.

Since the presence of this pathology can lead to the formation of blood clots in the heart area, this is fraught with the development of the next series of diseases, which, due to failure to provide timely treatment, medical care can be fatal:

• myocardial infarction;
• stroke;
• kidney infarction.

Signs and manifestations of pathology

Any disease is accompanied by the presence of its own symptoms.

Signs of an open oval window in childhood are as follows:

1. The baby's weight gain occurs very slowly.
2. In cases where a child cries, strains, screams, coughs, sharp blueness or severe pallor of the skin around the lips occurs.
3. The child often suffers from bronchopulmonary and colds.

At an older age, children may experience shortness of breath and increased heart rate when performing physical activity.

In adolescence, this pathology is reflected in the following signs:

• rapid fatigue of the body;
• frequent headaches;
• the presence of dizziness leading to fainting;
• the presence of interruptions in the functioning of the cardiac system.

In adulthood, especially if the age category is beyond 40 years, the signs will be as follows:

1. The presence of frequent colds and respiratory diseases.
2. Lack of pulse regularity.
3. The presence of weakness and high fatigue of the body.
4. The appearance of shortness of breath.
5. Presence of loss of consciousness.

Functioning heart problem

Preservation of the function of the oval window in cases of a measured life rhythm associated with the lack of frequent physical activity, does not pose a danger to the human body.

But there are cases in which maintaining the functionality of the oval window contributes to the development of a number of unpleasant consequences:

1. Age-related growth of organs and tissues, when the heart muscle grows, but the valve remains the same size. Blood, due to an increase in the oval window connector, can freely penetrate from one atrium to another, which leads to an increase in the load on them.
2. Diseases that increase pressure in the right atrium. This factor contributes to the opening of the valve towards the left atrium.
3. In cases of primary degree pulmonary hypertension, the preserved functionality of the oval window can have a positive effect on the human body. Part of the blood from the pulmonary circulation is discharged through the oval window into the left atrium, thereby helping to reduce pressure.

The presence of constant monitoring by a doctor is typical for these situations, so that the moment of transition to a decompensated state of the patient is not missed.

Of course, a person can live with this pathology full life. But everyone needs to be diagnosed for the presence of an open oval window.

Methods for treating an unclosed oval window

It should be said that an unclosed foramen ovale is a pathology in which there is a gap between the right and left atria. It can occur with noticeable symptoms, for example, pale skin, blue lips, hands and feet, frequent dizziness, loss of consciousness, and a predisposition to frequent colds.

This problem occurs most often in newborns. But there is no reason to worry, since it can go away in two years, and if it doesn’t go away, then special operations are currently being carried out using the latest methods.

However, it can occur without any symptoms, then there is no need for treatment.

If there is a small discharge of blood, there is no previous disease and there are no consequences after it, the operation is not performed.

Then such patients, if a transient ischemic attack or a history of stroke occurs, are prescribed general therapy with the following drugs to prevent thromboembolic complications:

1. Anticoagulants. The most popular anticoagulant is Warfarin (Coumadin). However, when using such medications, it is necessary to take frequent blood tests to monitor the state of the hemostatic system in order to protect the patient from blood clots.
2. Antiplatelet agents or antiplatelet drugs. The most common representatives of this group of drugs is Aspirin, used at 3-5 mg/kg every day. When aspirin enters the body, it acts on the platelet cell, which then remains inactive for some time to aggregation, or, more simply, to the process of gluing during the formation of blood clots. If Aspirin is used every day in small doses, this provides reliable prevention of venous insufficiency, as well as venous thrombus formation and ischemic stroke.

But in case of strong pathological discharge of blood, a low-traumatic x-ray endovascular occlusion of an unclosed window is performed from the atrium from the right side to the left. This entire procedure is controlled by special X-ray and echocardiological devices using an occluder, which, during opening, closes all holes.

The operation and the use of the drugs described above are used to treat an unclosed oval window, both in adults and children.

Help from folk remedies at home for this illness

Unfortunately, no folk remedies for this pathology have yet been identified.

If a person does not have obvious disorders in the functioning of the cardiovascular system, then doctors give him advice on how to lead a lifestyle, and may also prescribe some vitamins and proper nutrition that help support the functioning of the heart. It is also recommended for a person with an unclosed oval window to limit physical activity. And here medications in the absence of symptoms, the patient is not discharged; they can only prescribe procedures to strengthen the body, for example, hardening, exercise therapy, and sanatorium-resort treatment.

But if the patient has minor complaints about the heart when the oval window is not closed, the doctor sometimes prescribes special fortified medications that strengthen the cardiovascular system, such as Panangin, Magne B6, Elcar, Ubikhion, etc. And in case of severe disturbances in the functioning of the cardiovascular system, it is used general therapy with the drugs described above or undergo surgery.

Nutrition rules for an unclosed oval window

In addition to drug treatment for an unclosed oval window, you need to follow proper nutrition, which has some features. All people with such a difficult disease must adhere to a strict diet.

Namely, do not eat fried, smoked or salted foods. Include more fresh vegetables and fruits in your diet, as well as eat legumes, cereal crops, pasta, greens, low-fat lactic acid products, fish, low-fat varieties meat, as well as foods rich in potassium, such as grapes, kiwi, citrus fruits, baked potatoes and many others. Eliminate strong tea and coffee from your diet; it is better to replace them with freshly squeezed juices and dried fruit compotes. Food should be taken in small quantities and often.

Below is sample menu with 5 meals a day:

1. Breakfast - pumpkin porridge, wholemeal bread, a glass of kefir, 1 apple, 1 orange.
2. Second breakfast - 1 banana, 1 apple.
3. Dinner - pea soup, a piece of boiled lean fish, a piece of bread made from second-grade flour, dried fruit compote.
4. Afternoon snack – skim cheese, kefir.
5. Dinner – boiled potatoes with boiled chicken breast, second-grade bread, dried fruit compote, 1 orange.

Under no circumstances should you drink alcohol or smoke. Sleep time should be between 8 and 12 hours. Do light exercise. It is also very useful to eat more nuts when dealing with this problem, because they help normal operation hearts.

Possible complications and prognosis of an unburied oval window

In many cases, there are almost no complications with this pathology.

This unusual structure of the heart sometimes causes the following problems:

• myocardial infarction;
• stroke;
• kidney infarction;
• transient change in cerebral circulation.

All these problems occur due to paradoxical embolism. Although this happens extremely rarely, the patient is always obliged to tell his doctor that he has a patent foramen ovale.

Almost always, the prognosis for people with this disease is not very dire, and, as already mentioned, it ends without complications at all.

People with this problem should always follow these recommendations:

• be examined by a cardiologist every year;
• undergo an Echo-CG test;
• do not engage in strenuous sports;
• exclude work associated with heavy respiratory and cardiac stress, for example, divers, firefighters, astronauts, pilots, etc.

Surgery is considered only in the most emergency situations, during pronounced changes in the performance of the cardiovascular system and respiratory organs.

And in conclusion, we can add that an unclosed oval window is a pathology that does not cause much harm to a person’s health and life, unless there is a risk of a defect or some kind of heart disease. This depends on numerous factors.

Indications for abdominal ultrasound

At the moment, ultrasound, or ultrasonography, is one of the most popular diagnostic methods. It is non-invasive - that is, ultrasound does not require any disruption of the skin - and, accordingly, is absolutely painless. Discomfort can only be caused by the fact that the special gel that is used to lubricate the skin of the abdomen before the examination is usually cold.

Ultrasound is prescribed quite often: for any discomfort in the abdominal area, since it is often on the basis of this study that a preliminary diagnosis is made.

Indications for it may include:

1. Pain in the abdominal area, especially acute.
2. Nausea.
3. Increased gas formation.
4. Belching.
5. Changes in the shape or size of the abdominal organs, revealed visually or by palpation.
6. Suspicion of the presence of pathological formations in the abdominal cavity or organs: benign or malignant tumors, stones in the gallbladder.

The causes of increased gas formation, nausea and pain are usually clarified during ultrasound examination. In addition, such research “catches” even the smallest stones - they often become the causes severe pain. And it is done much faster than a blood test, making it easy to make a diagnosis even before the results of urine and blood tests arrive.

In addition, an abdominal ultrasound is performed if diabetes is suspected.

How is ultrasound performed?

An ultrasound examination is performed to examine the following abdominal organs:

• liver;
• spleen;
• gallbladder;
• pancreas;
• The lymph nodes;
• blood vessels.

I would like to draw your attention to the fact that the bladder belongs to the pelvic organs, that is, in the list of organs for which it is performed ultrasound diagnostics abdominal cavity, not included. Another important detail is that the organs of the digestive system located in the abdominal cavity: the stomach, intestines, except for the caudal section, are not subject to ultrasound due to the large accumulation of gases. Therefore, they prefer to use other diagnostic methods to study them.

Typically, an ultrasound is performed in the morning - this is much easier due to the patient's need to follow a diet. After all, if the study is scheduled for afternoon, the patient will have to not eat for a long time. Conducted by a highly specialized doctor whose task is correct execution diagnostics and interpretation of device indicators. An ordinary therapist or any other medical professional, without a trained ultrasound specialist, does not have the right to do this.

To conduct this study, doctors use special devices - so-called echotomoscopes. A gel is applied to the skin of the patient’s abdominal cavity, thanks to which ultrasonic waves pass freely through the patient’s skin, as a result of which the image on the device screen is stabilized. The doctor then moves a hand-held sensor over the patient's body. Sometimes, in order to better see a certain organ, it is necessary to hold your breath or change your posture.

Also, if you feel strong enough and sharp pains, It may be quite unpleasant for you strong pressure on the skin, which is sometimes required to obtain more accurate results.

Nutrition before ultrasound

Ultrasound diagnostics is a very important research method, therefore it is necessary to prepare thoroughly for it. Of course, if an ultrasound is performed urgently, it is simply impossible to prepare, since the diet must be followed for several days.

Three to four days before the test, you need to exclude from your diet the following foods:

• legumes, which are prohibited under no circumstances: they cause increased gas formation;
• flour products, including bread, any pastries;
• you will also have to give up raw vegetables and fruits;
• dairy products and milk itself are prohibited;
• should not be eaten sauerkraut, raw, too, however;
• carbonated drinks.

In addition, you will need to do without bad habits for at least a few days. Drinking drinks containing alcohol, smoking is prohibited, even chewing gum is a prohibited product.

Doctors recommend a cleansing light diet. You can eat lean meat or fish: boiled or steamed, stewed or boiled vegetables, cereal porridge. They are prepared in water and added minimal amount oils and salt.

Also to mandatory requirements includes the need to drink plenty of fluids. These days you should consume at least one and a half liters of fluid, or better yet, even more. Water and unsweetened tea are allowed, at least with a very small amount of sugar. Coffee and juices will have to be excluded before the ultrasound.

The last meal should occur no later than five hours before diagnosis. This is important: a full stomach or intestines prevents the specialist from examining the abdominal organs in detail; moreover, they are compressed, which can lead to inaccurate data. For the same reason, overeating is excluded a few days before the study; you need to eat fractionally, in small portions.

How to prepare for an abdominal ultrasound if you have problems with increased gas formation

This happens quite often - many people experience increased gas formation or constipation. In this case, you should take the advice of doctors and take a short course of medications. And after the ultrasound, you can continue the course of these pills to bring your intestines back to normal.

So, if your intestines are swollen, you need: Enterosgel and/or Smecta. These drugs help normalize the amount of gases formed in the intestines. In addition, it is often prescribed Activated carbon, but its popularity is gradually declining, as modern drugs show themselves to be more effective than traditional remedies.

In the opposite situation - with constipation - you may be prescribed Festal or Mezim Forte. They help improve secretory function intestines. You should also take care of cleansing your intestines. The evening before the test, take a laxative.

If this does not help, put on a rectal suppository - they are sold everywhere in pharmacies, for example, Bisocadil or Dulcolax. You can also do a cleansing enema, but this should never be overused, as it can damage the intestinal mucosa. One enema is quite enough, and only if it does not help at all, you can give a second one.

Also for people who have problems with gastrointestinal tract, you should be as precise as possible with your diet. Those who have flatulence should completely exclude vegetables from the diet, even boiled ones, replacing them with porridges: for example, pearl barley or wheat. For people with constipation, on the contrary, it is better to increase the amount of boiled or stewed vegetables: they weaken the intestines. But porridge should be consumed with caution, just like meat. Despite the fact that this is the most light diet, cereals and protein foods can cause constipation.

Recently, more and more often, after a regular visit to the doctor, mothers are informed that their child has a patent foramen ovale. These words may cause shock and cause for concern. But few people know that this window is necessary for the fetus to have normal blood circulation and provide it with oxygen in the womb.

With the normal development of the baby after birth, this hole closes or this may happen a little later. But there are cases when this does not happen, and then doctors give certain recommendations on nutrition, lifestyle and treatment.

Any abnormal changes in your child should be monitored. Modern young mothers need to remember that your baby is directly related to you. Therefore, everything you consume during pregnancy is passed on to the fetus. So what is an oval window in the heart in children, why is it necessary, what are the reasons for its not closing, as well as treatment methods. You will learn all this information in this article.

Foramen ovale in the heart in children - general information

Foramen ovale in the heart in children

A physiological feature appears in the embryo during intrauterine development. The two atria are connected by an opening through which blood passes. The fetal lungs are compressed and do not function; they do not require oxygenation through the blood.

This arrangement of the heart accelerates the blood circulation cycle and saturation of the organs that need it (primarily the brain and spinal cord). When a child is born, takes his first breath, his lungs open and begin to function fully.

There comes a need for sufficient blood supply to them. The hole in the heart becomes unnecessary. It begins to close after the first breath due to increased pressure in the left atrium.

Nature provides a valve that closes and blocks the flow of blood. Ideally, the window closes within the first five hours of life and disappears completely by the age of 1 year. An open window in the heart in a two-year-old child is also considered normal.

Having closed with a valve, it is gradually overgrown with connective and muscle tissue. In some cases, when examining a child, doctors discover an unclosed hole. If this occurs over the age of 2 years, then a minor anomaly of cardiac development is diagnosed.