Open foramen ovale in newborns, adolescents and adults: a problem that needs to be treated? What is an open oval window in the heart in newborns, when should it close? Heart surgery open foramen ovale.

The foramen ovale is a small opening located in the septum directly between the right and left atria. Normally, they should not communicate with each other so that there is no mixing of arterial and venous blood, as well as pressure drops. This condition is a pathological phenomenon in adults and children of a certain age and is very common. Sometimes the disease does not cause serious physical discomfort, but in some cases it can lead to various disorders in the functioning of the cardiovascular system and requires treatment.

The presence of an oval-shaped depression is the norm, because during pregnancy, while the lungs of the fetus do not function and its body needs additional oxygen, blood is transferred to the left atrium through this opening. The absence of such a duct in the process of intrauterine development can lead to various anomalies and even death of the child before birth or immediately after it.

When the baby takes his first breath, the respiratory system starts working, and his lungs immediately straighten out. Increased pressure in the left side of the heart stops the flow of blood through the foramen ovale.

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


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

  • smoking and drinking alcohol during pregnancy;
  • various malformations of intrauterine development (including infection with infections);
  • medication not agreed with the doctor;
  • hereditary factor.

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

Symptoms

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

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

  • diseases of the respiratory system;
  • impaired blood circulation of the brain and a tendency to thrombosis;
  • phlebeurysm;
  • severe headaches of a chronic nature;

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

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

Possible Complications

An open window in the heart rarely poses a serious threat to human health and practically does not affect life expectancy, but worsens its quality. But this pathology, in combination with other chronic respiratory diseases, varicose veins and thrombophlebitis, can lead to serious complications, which include:

  • myocardial infarction;
  • kidney infarction;
  • stroke.

In addition, there may be a temporary disruption of the blood supply to the brain, which can lead to memory loss, CNS depression, body immobility, numbness of the limbs and speech defects. After a while, these symptoms may disappear without a trace.

Treatment of the disease

If during a physical examination an open depression in the heart was revealed, but it does not bring any physical discomfort to a person, then special treatment is not carried out. With minor complications, various drugs are prescribed to prevent the formation of deep vein thrombosis.

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

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

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

Forecast

This disease in general has a good prognosis, but in order to avoid various complications, it is required to periodically conduct an ultrasound examination (especially for newborns) and visit a cardiologist. Physical overwork and increased stress should also be avoided.

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

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

With the advent of ultrasound diagnostics in medicine, young parents increasingly began to learn from doctors that the baby's oval window was not closed. Hearing such a diagnosis, one should not panic, because the baby reacts sharply to mother's emotions. All parents should be aware of what an open oval window in the child’s heart means, what symptoms the pathology causes, how dangerous it is and what are the ways to eliminate it.

The foramen ovale in the heart of some babies does not close with a valve after birth

What is a disease

In the area of ​​the left ventricle, the window is closed thanks to a small valve, which is finally formed by the time the baby is born. When a newborn starts screaming for the first time, the lungs open, blood flow to them increases, and the pressure in the left atrium increases, and the oval window in the heart of the newborn is covered with a valve. Over time, its strong fusion with the interatrial septum occurs. However, the important point is that the body of each person is individual and not all of them happen at the time of birth.

Many parents are frightened by this phenomenon and they are interested in the doctors when the oval window in the child's heart closes. In fact, it interferes with the proper functioning of the blood circulation, so it must gradually close. This happens with the help of valve growth to the edges of the interatrial septum.

An open foramen ovale is a heart anomaly, not a heart defect.

The duration of this process is different for all children - for some, the hole closes immediately, for others - after a year or two, and for someone - after five years. This is absolutely normal, and if other diseases associated with the cardiovascular system are not observed, then you should not worry.

Sometimes it happens that the size of the valve is not enough to completely cover the gap. Under such circumstances, an open oval window in the heart of an adult or a child is diagnosed, since this pathology remains for life. This phenomenon is not considered a disease, but an anomaly in the maturation of the heart.

Children with this diagnosis, reaching the age of 3, receive the second group of disability.

What is an oval window in the heart of the fetus and newborn is described in the video:

Why won't the oval window close?

An open oval window in newborns is an absolutely natural phenomenon, since when a child develops in the mother's womb, it is vital for him. However, if the functioning oval window has not closed 5 years after the birth of the child, it is worth considering. Consider why this pathology can occur:

  • most often this problem is hereditary, which is transmitted mainly from relatives of the first line;
  • if, when carrying a baby, a pregnant woman allowed herself to regularly drink alcohol or smoke often;
  • the problem can be provoked by the bad ecology in which a woman is expecting a baby;
  • if, the expectant mother ate improperly;

In most cases, the problem is caused by a genetic factor and is inherited from parents.

  • with regular stressful and depressive conditions in which a woman was while carrying a baby;
  • if there were toxic poisoning during pregnancy;
  • when a child is born before the due date.

If the oval window in the child’s heart has not closed, then it must be registered and constantly monitored by a specialist.

How deviation manifests itself

Whatever disease a person encounters, they all manifest themselves in different ways and cause certain symptoms, an open oval window in the heart in children or adults is no exception. However, the severity of the signs depends on the size of the hole:

  • if the open oval window in the heart of a child is from 2 mm to 7 mm, such a deviation is considered insignificant and makes itself felt only during strong physical exertion;

Bad habits of the mother during pregnancy can provoke the development of heart abnormalities in the baby

  • it happens that the gap between the atria is from 7 to 10 mm, under such circumstances the signs are more pronounced and practically do not differ from the symptoms of an atrial septal defect.

In newborns, an anomaly in the development of the heart is manifested as follows:

  • when a child cries, strains, or coughs, his nasolabial triangle, tip of his nose, or fingertips may turn blue;
  • the skin of such children is paler than that of others who do not have pathologies;
  • infants also have a rapid heartbeat.

Symptoms of pathology depend on the size of the hole

In adults who have had such a pathology, lips may also turn blue under certain circumstances:

  • when a person holds his breath for a long time, swims or dives, this is explained by the fact that during such procedures the pressure in the pulmonary vessels increases;
  • due to heavy physical exertion;
  • in the presence of diseases associated with the lungs;
  • if there are any other pathologies of the heart.

If the window size is more than 7 mm, then the symptoms of the pathology are as follows:

  • there is a systematic loss of consciousness;
  • the skin turns blue even in the absence of strong physical exertion;
  • worries about general weakness throughout the body, dizziness;
  • the child may lag far behind in development from their peers.

The skin integuments in babies with an anomaly of the heart are pale in color.

Diagnostic methods

On a routine examination, the cardiologist is unable to diagnose a patent foramen ovale in a child because there is no heart murmur on auscultation. To diagnose pathology, there are the following procedures:

  • Echocardiography (ultrasound of the heart). Thanks to this study, the doctor has the opportunity to understand in which direction blood circulation occurs, how much blood flows between the right and left atria, and also to determine the presence of other serious pathologies. These points are very important in the course of diagnosis, with the help of them the specialist understands at what stage the disease is and prescribes effective therapy.
  • Contrast echocardiography. This procedure shows if there is an open foramen ovale in the heart of a child or an adult. To identify the pathology, the patient is injected intravenously with saline. If a gap is present, then the reaction will occur immediately, and the doctor will see how air bubbles penetrate through this hole from one atrium to another.

Ultrasound of the heart allows to reveal in detail violations in the structure of the organ

  • Transesophageal echocardiography. This study is carried out if it is necessary to find out exactly where the gap is located and what size it is. Also, with the help of the procedure, it turns out whether there are any complications in the form of inflammatory processes in the heart valves, blood clots, or expansion of the heart.
  • Chest x-ray. It shows the size of the patient's heart, the diameter of the heart vessels, and also determines whether blood has stagnated in the lungs.

What is dangerous pathology

An open oval window in the heart of a newborn is diagnosed very often, and this is normal, but if it does not close after some time has passed, then there is a reason to contact a cardiologist.

There is no need to panic with this diagnosis, since such an anomaly almost never affects a person’s activity or life expectancy.

An anomaly of the heart caused by the formation of an open window requires observation by a cardiologist

However, it should be remembered that the oval heart window in adults increases the possibility of blood clots, which is why there is a possibility of the following complications:

  • The disease can cause the death of some areas of the brain, which is fraught with a stroke.
  • Impaired functioning of the heart causes the death of sections of muscle tissue, which can cause a myocardial infarction.
  • Due to impaired blood circulation, kidney cells can die - an organ infarction will occur.
  • In case of circulatory disorders in the brain, a person’s speech can be deformed, memory lapses are noted, the upper and lower limbs go numb. Symptoms last for a day, after which they disappear on their own.

It is important to understand that no matter what medical therapy is prescribed to the patient, the risk of these complications will not decrease.

When a child complains, he is prescribed medication

Methods of treatment

If an open oval window in the heart of an infant is diagnosed, then before the child is 5 years old, no medical therapy is required, this is due to the fact that during this time it can close on its own. If this did not happen, and the pathology does not make itself felt in any way, and does not prevent the child from developing normally, then there is no need to treat the problem.

If there are mild symptoms, and complications with the emergence of new diseases are not observed, then surgery is not prescribed. However, the patient is prescribed drug therapy:

  • The condition is relieved by anticoagulants. One of the most effective drugs in this group of drugs is Warfarin. If the patient is taking this drug, then there is a need for frequent blood tests so that doctors can monitor the state of the hemostasis system in order to avoid education.

By the age of 5, in most young patients, the foramen ovale closes.

  • Also, a person is prescribed treatment with antiplatelet agents or antiplatelet drugs. One of the most common and effective means of this category is aspirin, which must be taken daily at 3–5 mg per 1 kg of body weight. If you adhere to this method of treatment, it is possible to prevent venous insufficiency, the formation of blood clots, as well as ischemic stroke.

If the foramen ovale in the heart of the newborn has not closed, and the symptoms are severe, X-ray endovascular occlusion of the open hole is required. Throughout the operation, the doctor monitors the patient's condition with the help of special X-ray and echocardiological devices.

Patients after surgery due to a large oval hole in the heart permanently get rid of the pathology

Prognosis for an open foramen ovale in the heart

A small functioning oval window in newborns throughout life does not interfere with either social or work life. However, people with such a diagnosis should avoid extreme sports, strong physical exertion and professions that are associated with it.

Non-closure of a large foramen ovale requires surgical intervention. For six months after the completion of the operation, in order to avoid bacterial endocarditis, patients are advised to take antibiotics, as well as systematically visit a cardiologist. However, after the recovery period, a person can continue to live without limiting himself in anything.

What lies behind the diagnosis of "open foramen ovale"? Does this anomaly pose a threat to life? What are the reasons for it? How common is it? What treatment is required? These and other questions of the portal were answered by a cardiologist of the highest qualification category, a freelance city specialist in cardiology in the city of Gomel Irina Zabiran.

1. Is an open oval window a heart defect?

– No, an open oval window is classified as a minor anomaly in the development of the heart. All babies are born with a hole between the left and right atria with a valve. In healthy term infants under normal developmental conditions, the foramen ovale usually closes and ceases to function in the first 12 months of life. Sometimes the process of overgrowing the "window" is delayed up to 2 years. There are times when the window remains open for up to 5 years and even throughout life.

2. How common is this anomaly?

- Its prevalence is quite high. According to statistics, an open oval window of the heart has 40-50% of healthy children under the age of 5 years and from 10 to 35% (according to various sources) of the adult population.

3. What are the reasons for non-closure of the foramen ovale?

- As I have already noted, all children are born with an open oval window of the heart. In most cases, the valve closes tightly and is completely overgrown with connective tissue - the open oval window disappears. Sometimes the hole closes partially or does not grow at all. And then, under certain conditions (for example, with a cough, crying, screaming, tension of the anterior abdominal wall), blood is discharged from the right atrial chamber to the left. The main reason for this pathology is the genetic factor. Valvular occlusion has been proven to persist in people with a predisposition to hereditary connective tissue dysplasia (impaired development of connective tissue). The decrease in strength and formation of collagen in the connective tissue is also evidenced by pathological joint mobility, decreased skin elasticity, prolapse ("sagging") of the heart valves, myopia, etc.

Non-infection oval window in children may be due to factors such as:

– impact of unfavorable ecology, especially during pregnancy;

- taking non-steroidal anti-inflammatory drugs during pregnancy (these drugs cause a decrease in the level of prostaglandins in the blood, which are responsible for closing the oval window);

- drinking alcohol and smoking during pregnancy;

- premature birth (in premature babies, this pathology is diagnosed more often).

In adults valve opening oval window can provoke significant physical exertion. At risk are athletes involved in weightlifting, wrestling, athletic gymnastics, as well as divers and divers diving to a considerable depth. The latter are 5 times more likely to develop decompression sickness.

4. What complications and consequences are fraught with an open oval window?

– Most people with this anomaly are unaware of it and lead a normal life. An open foramen ovale usually does not cause hemodynamic disturbances and does not adversely affect human health. Complications can occur with an enlarged open oval window. So, if it exceeds 7-10 mm in diameter (according to echocardiography), the risk of blood clots in the heart increases. This can provoke the formation of a paradoxical embolism, which is manifested by signs of a transient ischemic attack or stroke, myocardial infarction, kidney infarction.

5. By what signs can this anomaly be suspected?

– Most often, the disease is detected incidentally during other examinations or complications. An open foramen ovale has no specific external manifestations and in most cases proceeds latently, sometimes it can be accompanied by poor symptoms.

Indirect signs of an open oval window may be: a sharp pallor or cyanosis of the skin in the area of ​​​​the lips and nasolabial triangle during physical exertion (crying, screaming, coughing, straining, bathing a child); tendency to frequent catarrhal and inflammatory bronchopulmonary diseases; slowing down the physical development of the child (poor appetite, insufficient weight gain); low endurance during physical exertion, combined with symptoms of respiratory failure (dyspnea and tachycardia); sudden fainting and symptoms of cerebrovascular accident (especially in young patients, with varicose veins, thrombophlebitis of the lower extremities and small pelvis).

Patients with an open foramen ovale may experience frequent headaches, migraine, postural hypoxemia syndrome - the development of shortness of breath and a decrease in arterial oxygen saturation in a standing position with an improvement in the transition to a horizontal position.

6. At what age is an open foramen ovale usually detected?

- Most often, this anomaly is diagnosed in 5-6-year-old children, when pediatricians begin to examine them before school. They listen to a heart murmur, which is no longer considered normal by this age, and refer small patients for additional examinations. Also, an open oval window is often found in young men aged 15-17 during the period of scheduled medical examinations of persons of pre-conscription age.

7. What methods are used to diagnose this anomaly?

– To establish an accurate diagnosis, instrumental studies and imaging methods are used: ECG (at rest and after exercise), conventional and Doppler echocardiography, supplemented by a test with bubble contrast and a strain test (Valsalva's test), chest x-ray, probing of the heart cavities.

With an open oval window on the electrocardiogram, there may be changes indicating an increase in the load on the right atrium. Older individuals with an open foramen ovale may show radiological signs of enlargement of the right heart chambers and an increase in blood volume in the pulmonary vasculature.

In older children, adolescents, and adults, transesophageal echocardiography is the gold standard for detecting a patent foramen ovale. It allows for differential diagnosis with atrial septal defect - a real heart disease.

The most informative, but more aggressive method for diagnosing an open oval window is cardiac probing. It is carried out immediately before surgical treatment in a specialized cardiosurgical hospital.

8. What treatment does an open foramen ovale require?

– In the absence of symptoms of an open foramen ovale, treatment is not prescribed. In children under the age of 4-5 years, the window may close on its own.

Patients with an open foramen ovale in the presence of an episode of transient ischemic attack or a history of stroke for the prevention of thromboembolic complications are prescribed systemic therapy with anticoagulants and antiplatelet agents (warfarin, aspirin).

The need to eliminate the open foramen ovale is determined by the volume of shunted blood and its effect on the functioning of the cardiovascular system. With a small discharge of blood, the absence of concomitant pathology and complications, surgery is not required.

With a pronounced pathological discharge of blood from the right atrium to the left, a low-traumatic X-ray endovascular occlusion of the open oval window is performed. The operation is carried out under X-ray and echocardioscopic control using a special occluder, which, when opened, completely clogs the hole.

If the patient has minor complaints about the functioning of the cardiovascular system, doctors may prescribe drugs that provide additional nutrition to the heart muscle (magne B6, panangin, analogues of L-carnitine, coenzyme Q).

9. What lifestyle recommendations should be followed with an open foramen ovale?

It is necessary to ensure that the child fulfills the daily routine, does not suffer from physical and psycho-emotional overload. In the diet, you should adhere to a protein diet, consume a sufficient amount of vegetables and fruits. Also, you can not run any, even the most, at first glance, minor infections: any failure of the body can adversely affect the work of the heart. Older children with an open foramen ovale are contraindicated in swimming, scuba diving, and some types of physical activity that require breath holding.

In the presence of such an anomaly of the heart, the danger to life is the profession of a diver, a diver. With a rapid descent to a depth, the gases dissolved in the blood turn into bubbles that can penetrate the shunt of the oval window into the arteries and cause an embolism leading to death. For the same reason, people with an open oval window are not allowed to professional activities associated with overloads (pilots, astronauts, machinists, dispatchers, drivers, operators, scuba divers, submarine crew, caisson workers). It is also dangerous to engage in recreational diving.

The operation performed for the open oval window allows patients to return to their normal rhythm of life without restrictions. In the first 6 months after surgery, antibiotics should be taken to prevent the development of bacterial endocarditis.

Examination for the presence of an open oval window is desirable for patients with varicose veins, thrombophlebitis, cerebrovascular accident, chronic lung diseases, since they may develop paradoxical embolism. If a risk of thrombosis is detected, the doctor prescribes blood thinning medications.

When carrying out any surgical interventions in patients with an open oval window, it is necessary to prevent thromboembolism, namely: elastic bandaging of the lower extremities (wearing compression underwear) and prescribing anticoagulants several hours before surgery. The presence of this anomaly must be warned by your doctor.

Interviewed by Irina Bareyko

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. The oval window 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 especially 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 the norm, but if the anomaly develops at an older age, then it is necessary to be regularly examined by a doctor, because the disease has severe complications.

An open oval window 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 wall of the septum. But in some cases, the valve is very small in order to close the gap, and then the pathology becomes aggravated.

The causes of an open oval window in the heart in a child of 6-7 years old are determined by several factors:

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

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

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

An open oval window in the heart in an adult is a consequence of the neglect of medical methods in identifying a disease or a lack of diagnosis throughout life, caused by the incompetence of research methods. Sometimes a defect is detected when examining others, when a violation of the functions 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 cyanotic lips () after physical exertion and pallor of the face.

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

  • regular cyanosis of the lips and the area around the mouth, regardless of previous actions;
  • lag in physical development;
  • violation of coordination of movement;
  • dyspnea;
  • unexpected fainting;
  • migraines and other types of headaches;
  • frequent colds;
  • the appearance of blood clots;
  • VSD -;
  • numbness of the limbs;
  • an 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 a change in the skin appears after holding your breath under water, strong physical exertion, as well as other heart and lung diseases.


Diagnostics

With 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 to reveal in detail violations in the structure of the heart;
  • probing the cavities of the heart to study 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 in 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 sounding 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 state of health, another type of study is used - ultrasound of the heart.

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

With a small size of the gap and the absence of symptoms that interfere with the quality of life, medication and inpatient treatment are not prescribed.

  • increase the immune protective functions of the body due to 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 oval window in the heart can affect the cardiovascular system, causing disturbances in the conduction of the organ and sudden pressure surges.

In such cases, it is mandatory to prescribe medication to stabilize the work of the heart:

  • preparations containing magnesium;
  • vitamins and drugs that improve the interaction between the chambers of the heart;
  • pills that stimulate the production of energy by the point sections of the heart.

With a large hole with the formation of blood flow in the left atrium, surgical intervention is indicated, on the eve of which thrombosis is prevented. Some time before the operation, the patient is put on elastic bandages on the lower extremities and prescribed drugs that inhibit blood clotting processes.

During surgery, a patch is inserted through the femoral vein using a catheter into the right atrium. When ingested, it opens 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 oval window in the heart is closed. The operation is recommended only in difficult cases, when the size of the gap portends complications and is quoted as a heart defect.

The method of treatment with 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 the operation, which is inserted according to the same principles as the patch.

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


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

Complications

In the absence of compliance with the recommendations from the doctor, even a slight gap in the chambers of the heart can lead to serious illnesses leading to sudden death. To avoid aggravating consequences, it is necessary to exclude excessive physical exertion, including immersion under water, 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, blood vessels and leads to paralysis, death;
  • paradoxical embolism, during which a blood clot breaks off, clogging vital arteries and posing a threat of death in case of its large size;
  • septic endocarditis, affecting the heart channels and causing death;
  • a stroke that occurs when a blood clot forms in a cerebral artery;
  • myocardial infarction caused by blockage of the coronary arteries of the heart by a thrombus;
  • kidney infarction with blockage of the corresponding vessels;
  • violation of cerebral blood supply, in which motor and auditory functions are damaged and memory disorder occurs.

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

Forecast

If you follow the doctor's requirements and see a cardiologist once a year, then the prognosis of an open oval window in the heart will be quite favorable. You can be sure of longevity and not feel tormenting symptoms if you do not overwork in physical exercises, do not dive under water and try to fly less on an airplane. Any actions that cause an increased load on the circulatory and respiratory system lead to complications.

Patients who have undergone surgery for 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 the previous restrictions in their lifestyle. However, if the size of the gap does not go beyond the norm, it is not recommended to perform the operation, because the pathology, to a greater extent, is in the nature of structural features of the heart, and not a serious illness. The threat to the patient's life is caused only by complications that have developed against the background of pathology.

Risk group

There are a number of professions that can have a fatal effect on the health of people with an open oval window in the heart.

It is sad that untimely diagnosis of pathology or neglect of one's own well-being leads to death. And all because with a strong immersion or rise, blood clots can form in the artery, blocking the vessel and portending instant death.

People with an open oval window in their heart should exclude the following professions and even a one-time hobby from their lives:

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

When serving in the armed forces, conscripts must perform powerful physical activity daily. Since the number of deaths in the army has increased, and the main reason for this is heart disease, the medical examination began to carefully examine each conscript. When diagnosing an open oval window in the heart, they become unfit for service and are sent for treatment in order to avoid separation of a blood clot and blockage of blood vessels that pose a threat to life.

The pathology of the heart caused by the formation of an open oval window is not a sentence, but it 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 right 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 an airplane, experience exhausting physical exertion, then you can predict the development of an embolism with a probability of 80%, in which disability or death occurs.

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

Circulation

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

Anatomy

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

General information about pathologies

One of the main tasks of medicine today is the treatment of heart disease. According to statistics, mortality from CVD pathologies is growing annually throughout the world at a rapid pace. A study of the causes of diseases of the cardiovascular system showed that some of them are caused by infection, others are hereditary or congenital. The latter are diagnosed quite often. As a rule, such pathologies do not manifest themselves and are detected only during preventive examinations. However, there are several congenital pathologies, the clinical picture of which is clear. So, for example, if the lumen in the aorta is too narrow, blood pressure rises sharply in the upper and decreases in the lower region of the body. With such a congenital pathology, a complication may be a hemorrhage in the brain. Patients are often diagnosed with any holes in the partitions. Also, the open oval window in the heart may not overgrow, the botallian duct (a vessel connecting the aorta and artery in the prenatal period) may remain.

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

Open oval window in the heart

It functions in humans during the embryonic period. During the first year of life, the child's foramen ovale usually heals. However, in some cases this does not happen. The location of the hole is the interatrial septum. An open foramen ovale with non-closure can be manifested by delayed physical development, cyanosis in the region of the nasolabial triangle, tachycardia and shortness of breath. Sudden fainting, headaches, bronchopulmonary pathologies and frequent SARS are also noted.

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

Relevance of the problem

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

Infection process

Newborns always have an open oval window. After the first independent breath, the pulmonary circle of blood flow is turned on (it begins to fully function). Over time, the open oval window in the child should be overgrown. This is due to the higher pressure in the left atrium compared to the right. Due to the difference, the valve is closed. Then it is completely overgrown with connective tissue. This is how an open oval window disappears in a child.

Causes of the problem

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

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

Risk factors

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

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

Features of hemodynamics

The bottom of the fossa ovale on the inner left side of the wall of the right chamber is the place where the open foramen ovale is located. Dimensions (the average is 4.5 mm) may be different. In some cases, they reach 19 mm. As a rule, the hole has a slit-like shape. An open window, in contrast to a defect in the interatrial septum, is distinguished by a valvular structure. It ensures the inconsistency of the message between the chambers, the possibility of ejection of blood only in one direction (from a small to a large circle).

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

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

Symptoms

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

Characteristic features

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

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

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

Diagnostics

The survey is carried out in several ways. Diagnosis includes ECG, ultrasound of the heart. An open oval window is examined using probing of the cavities, radiography. If there is a defect on the electrocardiogram, changes are observed that indicate an increase in the load on the right region of the organ in question.

In older patients, with the window open, radiological signs of an increase in blood volume in the pulmonary vasculature and an increase in the right heart chambers may be detected.

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

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

Therapeutic activities

In the absence of adverse symptoms, an open window may be considered a variant of the norm. For patients with an active hole in the presence of cases of ischemic transient attack or a history of stroke, systemic therapy with antiplatelet agents and anticoagulants (such as Aspirin, Warfarin, and others) is recommended as a prevention of thromboembolic complications. As a treatment control method, INR (international ratio) is used, which, with the window open, should be within 2-3 units. The need to eliminate the hole is determined in accordance with the volume of injected blood and its influence on the activity of the cardiovascular system.

With a small shunt, when the open foramen ovale is 2 mm or in the region of this indicator, surgery is usually not prescribed. In the case of a pronounced pathological reverse ejection of blood, low-traumatic X-ray endovascular occlusion is recommended. The operation is performed under echocardioscopic and radiological control. During the intervention, a special occluder is used, which, when opened, completely clogs the window.

Forecast

Patients who have been diagnosed with an open oval window in the heart are recommended regular examination by a cardiologist and echocardiography. After endovascular occlusion, patients can return to normal life without any restrictions. During the first six months after surgery, patients are recommended to take antibiotics. Such drugs are used to prevent the occurrence of bacterial-type endocarditis.

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

Finally

Experts recommend regular check-ups for patients at risk. These include, in particular, persons with varicose veins, disorders of cerebral circulation, thrombophlebitis, with chronic pulmonary pathologies, a predisposition to the development of paradoxical embolism. During pregnancy, a woman should be under close medical supervision, monitor nutrition and exercise.