Open oval window (hole) in the heart: causes, closure, prognosis. Open foramen ovale in a child's heart

Parents are somewhat anxious about the health of the newborn, so many diagnoses that doctors make immediately after birth are perceived with caution. Most often, after the first ultrasound, performed on the third day of the baby's life, an open oval window in the heart is diagnosed. Despite the apparent seriousness of the condition, children with such a pathology do not always require special treatment, but only monitoring the condition and regular visits to a specialist. As a rule, the window closes on its own when the child reaches a certain age.

Content:

What is an open window in the heart

The foramen ovale is an opening in the interatrial septum through which blood flows from the left atrium to the right. In the fetus in the womb, the lungs do not work, so the pulmonary circulation does not function, and the blood immediately flows through the open foramen ovale (OOO) from the vena cava into the systemic circulation. Thus, a gap is observed in any fetus.

After the birth and the first breath of the child, the lungs begin to work. As a result of the pressure difference, the gap is closed by a valve. Normally, the foramen ovale should close immediately after birth. But this is not always the case. In most newborns, the valve is too small to completely block the opening. The options for the norm are considered to be the closing of the window until the end of the first year of the baby's life. Often there are cases when it remains open until 3-5 years of age.

A diagnosis doesn't always have to be a cause for concern. It all depends on the size of the gap:

1. When the oval window is opened up to 3 mm, the pathology does not manifest itself in any way, it does not affect the work of the body and the state of the person.
2. If the oval window is open from 4 to 6 mm, manifestations can occur during significant physical exertion, at moments of rest it is imperceptible.
3. The diagnosis of "gaping oval window" is made when the gap reaches a size of 7 to 10 mm. This is already an atrial septal defect, similar in its manifestations to congenital heart disease.

Important: The oval window operating at birth is a pathology of the heart, but not a defect, as some parents think. Often with a small gap, treatment is not carried out at all. Many adults who are told about an open window in the heart during the examination were not even aware of their condition and led a full-fledged active life.

Video: Atrial septal defect in children

Why won't the window close?

More often than others, the cause of this pathology is called hereditary predisposition. In addition, predisposing factors are:

1. Smoking, use of alcoholic beverages and drugs by a woman during pregnancy. It is known that bad habits have a negative impact on the development of the fetus, especially in the first weeks, when all organs and systems are being formed and developed. Many women are unaware of pregnancy and lead a normal life. That is why doctors insist on preparing for pregnancy, planning it.
2. Feeding a woman while carrying a baby. Food should be natural, not contain carcinogens, preservatives and other substances that adversely affect the intrauterine development of the child. Toxins that enter the body of the expectant mother through the placental barrier penetrate to the fetus. First of all, the brain and the cardiovascular system suffer.
3. Poisoning by the expectant mother with food or chemicals, viral and bacterial diseases during pregnancy.
4. Constant worries and stresses, depressive states.
5. Preterm birth in most cases leads to the diagnosis of an open foramen ovale in a premature baby.
6. Intrauterine growth retardation or fetal hypoxia.
7. Prolonged labor, a long anhydrous period, asphyxia in a born baby.

It should be borne in mind that many congenital heart defects also cause an open window, therefore, when diagnosing this anomaly, doctors insist on a complete examination of the baby.

Alarming symptoms and diagnosis

The symptoms by which one can suspect the opening of the oval window are rather blurred, as they can be a sign of a number of other diseases. But if you find some deviations in the well-being and condition of the child, it is better to show the pediatrician in order to exclude pathologies:

• blue nasolabial triangle during crying, feeding and bathing;
• frequent SARS and other colds;
• poor appetite and low weight gain;
• murmurs in the heart when listening;
• at an older age, there is rapid fatigue, shortness of breath after a short activity.

On examination, which is carried out monthly for children of the first year of life, the pediatrician must listen to the work of the heart. If there are noises or other audible anomalies in the work of the organ, the child is sent for examination. It should be noted that no pathological changes are detected on the ECG with an open oval window, therefore, the main method for diagnosing PFO in a newborn is an ultrasound of the heart, which is performed on the 3rd day after birth, at 1, 3 and 6 months of life.

Treatment

If the size of the gap in children under 3-5 years old does not exceed 5 mm, then no special treatment is prescribed, preventive examinations every 3-6 months are enough, ultrasound control once a year. With an open window in children older than 5 years of age, they speak of pathology. With a small size of the gap and the absence of accompanying symptoms, as well as additional cardiac and chronic diseases of other organs, the child does not need medical treatment or any surgical interventions.

If the oval window is larger than 5 mm, the child is registered with a cardiologist. With complaints of discomfort or pain, frequent shortness of breath, fatigue, maintenance medications are prescribed.

If the gap is large, which causes a violation of blood circulation, heart function, and, as a result, heart failure, the child is shown surgical treatment. Modern technologies allow the operation to be carried out quickly and painlessly, without opening the chest and direct contact with the heart. A catheter is inserted into the femoral artery, and a device (occluder) is delivered to the heart through it, replacing the valve (it looks like a double-sided umbrella). After installation and opening, the occluder covers the open oval window, adjusting the functions and work of the atria.

Consequences of pathologies of the interatrial septum

An unclosed gap in a newborn is too small, therefore, when it is diagnosed, atrial overload and heart failure are not observed. As the child grows and develops, three options are possible:

• the oval window closes completely;
• the gap remains, has a small size;
• there is a growth of organs and vessels, the valve remains the same size.

In the latter case, free flow of blood from one atrium to another is possible, which significantly increases the load on the organ, therefore, appropriate treatment is carried out, which is prescribed only by a doctor (from maintenance therapy to surgical intervention).

Women with an open foramen ovale may experience difficulties during pregnancy associated with an increased load on the body and fetal pressure on all organs, including the heart. People with this pathology experience frequent migraines, dizziness, fatigue, shortness of breath.

One of the terrible complications is the development of paradoxical embolism, when emboli enter the bloodstream through the LLC, causing the risk of blockage of blood vessels, which leads to death.

For reference: Emboli are any particles (solid, liquid, gaseous) in the bloodstream that do not occur there under normal conditions. Emboli can be formed from blood clots (thrombi), fat, gas, microbes, tissue cells of the body or represent a foreign body that has entered the lumen of the vessel.

Many parents are afraid that playing sports can affect the quality of life of a child if the foramen ovale has not closed. Nevertheless, sport is not only not harmful, but is also indicated for such an anomaly, as it strengthens the heart muscle. The child can engage in almost any sport, except for deep-sea swimming and parachuting, as there will be sharp changes in pressure, which contributes to an increase in the size of the gap of the interatrial septum.

Video: For what pathologies should you contact a pediatric cardiologist

Congenital heart disease (CHD) is an anomaly in the development of the heart that develops at 2-8 weeks of gestation. According to statistics, heart disease in newborns occurs in 5-8 cases out of 1000.

Pathology Cause Under normal conditions
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One of the most common heart defects is the oval open window (FOA), a minor anomaly in which communication between the right and left atria is partially or completely preserved. In fact, such a hole in the heart is necessary for the full development of the fetus, so all newborns are born with it, and during the first year of life, sometimes for several years, it overgrows.

However, it happens that the hole does not overgrow. Depending on its size, the degree of violation of the circulatory process depends. If the opening is too large and there is no connecting valve between the atria, there is an atrial septal defect.

In addition to this vice, there are many others, including:

• patent ductus arteriosus (PAD) in newborns, in which oxygenated blood enters the lungs;
• defect of the aortopulmonary trunk - incomplete fusion of the septum between the aorta and the pulmonary trunk;
• ventricular septal defect (VSD) - a hole that separates the right and left ventricles;
• coarctation (narrowing) of the aorta;
• stenosis (narrowing) of the pulmonary or aortic valves.

The cause of the disease is the abnormal development of an organ inside the womb

It is important to note that in many cases, heart defects do not appear separately, but together. For example, the most common cause of cyanosis in a newborn is Fallot's tetrad, which combines VSD, aortic displacement, and ventricular hypertrophy.

Causes of cardiac anomalies

The nature of the disease remains unclear today, however, doctors identify the following causes of CHD:

• genetic predisposition, i.e., the presence of congenital malformations in the anamnesis of the infant's relatives;
• chromosomal disorders;
• gene mutations;
• infectious and viral diseases that a woman suffered in the first trimester of pregnancy;
• unhealthy lifestyle (drug addiction, smoking, alcoholism);
• taking certain medications during pregnancy (anticonvulsants, amphetamines, antibiotics);
• external factors (exposure to radiation).

The health of the father is important. Also risk factors include:

• late pregnancy;
• endocrine diseases in parents;
• severe pregnancy and the threat of termination in the first trimester;
• history of stillborns.

According to recent studies, children of obese women have an increased risk of being born with CHD and other pathologies of the heart and blood vessels.

Pathology is a congenital or acquired changes in the structures of the heart

Clinical manifestations and diagnostic methods

Congenital heart disease in newborns has different symptoms. They depend on the type of pathology and how it affects the health of the newborn.

An open oval window may not manifest itself for a long time, without causing any concern to parents. With non-closure and a significant size of the hole, breathing difficulties, pallor of the skin or cyanosis appear, there is a delay in physical development.

With more severe defects, parents immediately notice that something is wrong with the child. The most common symptoms of heart defects are.

1. Cyanosis is a blue discoloration of the skin due to a lack of oxygen in the blood. Depending on the type of CHD, only the nasolabial triangle, as well as the limbs and even the whole body, can turn blue.
2. Dyspnea. It is observed not only during activity, but also when the child is inactive.
3. Heart rhythm disorders. The most common symptom of heart defects is palpitations, tachycardia. But with some defects, there is also a reduced pulse, bradycardia.
4. Other symptoms, among which are the general weak condition of the child, lack of appetite, drowsiness, screaming in a dream. In severe pathologies, lack of air, loss of consciousness are possible.

Diagnosis of defects is carried out by a cardiac surgeon. In the presence of suspicious heart murmurs in a newborn, he will certainly be prescribed an ultrasound examination. Ultrasound of the heart (echocardiography) allows you to examine the condition of the valves and muscles of the heart.

As additional diagnostic methods are used:

• x-ray examination, including with the use of a contrast agent (ventriculography);
• electrocardiogram (ECG), as well as its varieties (treadmill test, bicycle ergometry).

Dr. Komarovsky recommends that you definitely undergo a thorough examination if suspicious heart murmurs do not go away within 3-4 days after the birth of the child, while blue skin, pale and cold limbs are also observed.

Why is LLC dangerous?

Under normal circumstances, the foramen ovale usually closes between 2 and 12 months after the baby is born.

For a long time, this defect was considered by doctors to be quite safe, with which people could live a full life and even actively play sports. Today, the opinions of doctors are divided. We can definitely say that children with an oval window and heart murmurs need careful medical supervision.

One of the most dangerous complications that can occur with a non-closure of the foramen ovale is paradoxical embolism, accompanied by an increased risk of thrombosis, stroke, or bacterial diseases.

It is important to note that often an open foramen ovale is combined with another defect - a heart aneurysm in newborns, and this is fraught with the risk of developing cardioembolic complications.

Thus, children with CHD require special attention and careful care. They are contraindicated in certain sports:

• scuba diving;
• weightlifting;
• diving to great depths;
• other exercises accompanied by holding the breath or straining.

Treatment of heart disease

The method of treatment for CHD depends on its severity. If a child has no other anomalies besides the PFO, the hole does not exceed 5 mm, there is no significant circulatory disturbance, his state of health does not cause concern.

Doctor cardiologist pediatrician will help in the treatment of the disease

Predominantly over time, the size of the oval ring decreases. Anticoagulants, drugs that thin the blood, may be prescribed to reduce the risk of blood clots.

With a large size of the foramen ovale (7-10 mm), one should speak of an atrial septal defect. Such holes are called "gaping", in this case, the issue of surgical removal of the anomaly is decided.

Modern surgical treatment of PFO involves the introduction of a special tube (catheter) into the artery, at the end of which there is a valve that completely clogs the oval window. Find out what causes blood clots after childbirth

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Attention!

The information published on the site is for informational purposes only and is intended for informational purposes only. Site visitors should not use them as medical advice! The editors of the site do not recommend self-medication. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your doctor! Remember that only a complete diagnosis and therapy under the supervision of a doctor will help to completely get rid of the disease!

Our article is devoted to this common pathology. In this material, the essence of the problem of a functioning oval window will be revealed to you.

In 1930, scientists examined about 1000 children's hearts, as a result, about 35% of the subjects had an open foramen ovale (PFO). Nowadays, the frequency of this phenomenon reaches 40% in the child population.

Why do I need an oval window for the fetus?

In the mother's womb, the child does not breathe in the truest sense of the word, since the lungs cannot function, they resemble a deflated balloon. A patent foramen ovale in newborns is a small opening between the atria. Through the foramen ovale, blood from the veins flows into the single systemic circulation of the fetus.

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

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

The exact cause of this pathology does not exist.

Allocate some of the most common factors.

1. In almost all premature and immature newborns, the window remains open.
2. Smoking, maternal substance abuse.
3. Intrauterine fetal hypoxia.
4. Prolonged labor, asphyxia of the baby in childbirth.
5. Unfavorable environmental factors.
6. Mother's stress.
7. genetic predisposition.
8. Congenital heart defects.
9. Occupational hazard with toxic substances in the mother.

Open foramen ovale in children and its symptoms

In most cases, these children do not complain.

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

What can be seen?

1. The appearance of blue around the mouth in a newborn. Such cyanosis appears after crying, screaming, while sucking, bathing.
2. In older children, tolerance (resistance) to physical activity decreases. The child is resting, sitting down after the usual outdoor games.
3. The appearance of shortness of breath. In general, normally, the child should easily climb the 4th floor without any signs of shortness of breath.
4. Frequent colds in infants, namely: bronchitis, pneumonia.
5. Doctors listen to a heart murmur.

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

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

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

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

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

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

What to do if the window has not closed after 5 years? Basically, nothing. The open foramen ovale in a newborn is too small to provide atrial overload with the development of heart failure. Therefore, it is necessary to dynamically monitor the baby, annually undergo an ultrasound of the heart and look around at a pediatric cardiologist.

PERSONAL EXPERIENCE. There was a 13 year old boy at the reception. For 4 years, the child has been involved in active sports - rowing. Accidentally, during the prophylactic examination, an ultrasound of the heart was performed, where for the first time a 4 mm oval foramen was found. At the same time, the child did not show any complaints for all his 13 years and coped well with physical activity. Even took first place in competitions.

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

These drugs improve myocardial nutrition and exercise tolerance.

Recently, it has become reliable that the drug levocarnitine (Elkar) contributes to the rapid closure of the oval window, if you drink it for 2 months at a rate of 3 times a year. True, it is not entirely clear what this is connected with. From personal practice, I can say that I did not see a clear connection between taking Elkar and closing the LLC.

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

As for sports and a functioning oval window, in the absence of complaints and good indicators of ultrasound of the heart, you can engage in any sport.

Complications

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

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

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

A normal heart is divided into two parts: left and right, separated by a septum - a membrane. The right side of the heart receives deoxygenated blood and sends it to the lungs. Oxygenated blood returns from the lungs and enters the left side of the heart, and from there it is sent to all organs. The septum prevents mixing of blood. However, some babies are born with a hole in the heart septum (top or bottom wall). A hole in the septum separating the upper chambers of the heart is known as an atrial septal defect (ASD), while holes in the lower part are known as a ventricular septal defect (VSD).

In both cases, purified blood is mixed with oxygenated blood. A large opening in an ASD can cause the lungs to overflow with blood and make it harder for the heart to work.

What causes a hole in the heart?

ASD and VSD are congenital heart defects. Typical causes of a hole are as follows:

• Genetics: A child has an increased risk of developing an atrial septal defect if one of the parents has a congenital heart disease
• Presence of other genetic disorders: Children with inherited disorders such as Down syndrome often have a heart defect from birth
• Smoking: Babies born to mothers who smoked during pregnancy are susceptible to various congenital heart defects.

What are the symptoms or signs?

Most children do not have any symptoms of ASD. However, symptoms may appear later in life, in the 30s or even later. Signs of an ASD include:

• Murmurs in the heart
• Fatigue
• Shortness of breath, palpitations
• bluish skin color
• Swelling of the feet, legs, or abdomen
• Stroke.

Symptoms of VSD appear soon after the baby is born - within the first few days, weeks or months. Symptoms include:

• Cyanosis, or a bluish tint to the skin, lips, and fingertips
• rapid breathing
• poor appetite
• Swelling of the feet, legs, or abdomen
• Heart murmurs (may be the only sign of a defect in some babies).

What examinations are needed to confirm or exclude violations?

ASD and VSD are diagnosed in the following way:

• Physical examination (the doctor listens to the heart and lungs with a stethoscope to detect heart murmurs)
• echocardiography
• Electrocardiogram (ECG)
• Chest radiograph
• Cardiac catheterization
• Pulse oximetry.

What treatment options are available to correct the disorder?

Many ASDs close on their own within the first year of a child's birth. Based on regular check-ups, the doctor can suggest treatment for a medium or large hole between two and five years of age. Treatment usually involves surgical procedures or catheterization to seal the hole:

• Catheterization is performed under anesthesia. The procedure involves inserting a catheter into a vein in the groin and passing up to the septum. Two small discs that are attached to the catheter are pushed out and close the hole between the atria of the heart. Over time, healthy tissue grows around the device (in six months)
• Surgery - during the operation, the surgeon closes the hole with a special patch.

A ventricular septal defect is simply controlled if it does not cause any symptoms. In situations that require treatment, this is done with:

• Supplementary nutrition - special feeding or nutrition for children who are developing poorly. May need breast milk, special supplements, use of a feeding tube or feeding bottle
• Surgery – large VSDs require open-heart surgery, which eliminates the hole in the septum.

Precautions are necessary to maintain health during the treatment of a hole in the heart

Children and adolescents treated with an ASD or VSD should have regular checkups with their doctor to monitor healing progress. Adults undergoing treatment should follow the doctor's recommendations before returning to normal daily activities.

Do not self-medicate.

In case of health problems, consult a doctor.

An open oval window in the heart of a child is a problem that is quite common in modern pediatrics. But what actually is such a violation and how dangerous is it to health?

What is a child?

During fetal development, the child's body is only from the mother's blood. Moreover, between the two atria there is this very oval window, due to which the cells of the central nervous system receive the maximum amount of blood saturated with oxygen and nutrients. Immediately after birth, the edges of the foramen ovale fuse. In most children, its closure occurs in the first days of life. In about 30% of infants, the foramen ovale remains at least partially open for up to a year. But sometimes this hole between the atria does not close - in this case, the baby needs qualified help.

An open oval window in the heart of a child and its causes

Unfortunately, it is far from always possible to find out the causes of such a pathology - and to this day, active research is being carried out on this issue. Nevertheless, it has been proven that such a violation is associated with the presence of other pathologies. The risk increases if a woman abuses alcohol and tobacco during pregnancy.

An open oval window in the heart of a child: the main symptoms

In fact, the presence of an open hole in the heart in most cases does not cause any visible symptoms. Quite often, pathology is detected quite by accident during an ultrasound examination of the circulatory system. However, there are a number of signs that you should still pay attention to:

• For example, quite often during screaming, crying or physical exertion, you can notice blue skin in the area of ​​​​the nasolabial triangle.
• Often, an open oval window in children leads to a slowdown in normal physical development.
• Signs can also include frequent colds and diseases of the respiratory system.
• As parents notice that the baby is almost incapable of physical activity, for example, respiratory failure may develop during active play.
• Children with this diagnosis can often lose consciousness due to circulatory failure in the brain.

Open foramen ovale and treatment

If there are disturbing symptoms, it is worth showing the baby to the doctor and telling him about all the suspicions. As a rule, in order to confirm the diagnosis, it is enough to do After the pathology has been detected, the child must be constantly under the supervision of a cardiologist and undergo regular examinations. As a rule, experts recommend that parents wait with radical treatment measures, since in most cases the foramen ovale closes on its own. In addition, statistics claim that in almost 25% of the adult population, the oval window has not completely closed. Only in especially severe cases, if the pathology poses a threat to the life of the child, the doctor prescribes a surgical operation, during which the hole is closed artificially.