Closed foramen ovale. Cardiology open foramen ovale. What is the "oval window" in the heart

An open foramen ovale is a temporary opening with a valve in the middle part of the interatrial septum, which separates the atria from each other, being their wall. In its center there is a recess - an oval hole, at the bottom of which there is an oval hole (oval window), equipped with a valve.

The fetus needs an open oval window in the heart for a number of physiological reasons: communication between the atria occurs through the oval window, which allows blood from the vena cava, bypassing the lungs that are not working in the prenatal period, to enter the systemic circulation. Premature closure of the foramen ovale during intrauterine development of a child contributes to the development of right ventricular failure, fetal death, and death of the child immediately after birth. Therefore, absolutely all children are born with an open oval window in the heart.

After birth, with the first breath, the baby’s lungs straighten out, and the baby begins to breathe on its own: the pulmonary circulation begins to work fully, oxygen enters its body from the lungs, and there is no need for communication between the atria. After birth, the foramen ovale closes as the pressure in the left atrium increases (becomes slightly higher than the pressure in the right atrium).

With a load in newborns and infants (crying, screaming, anxiety, feeding), which contributes to an increase in pressure in the right parts of the heart, the oval window begins to temporarily function. This is accompanied by a discharge of venous blood through the foramen ovale and is manifested by a blue nasolabial triangle. Then, in most children, the valve overgrows, and the foramen ovale disappears completely.

When should the foramen ovale close in a child's heart?

The open foramen ovale should gradually close as it interferes with normal blood flow through the pulmonary system. Closing of the oval window occurs gradually by accretion of the valve to the edges of the oval fossa and can last for each child individually- for someone right away, for someone in a year, two, or five. This is normal and, in the absence of other heart conditions, should not be of concern to parents. In 20-30% of cases, the opening between the atria is not tightly closed, and the foramen ovale may remain open throughout life.

In rare cases, the foramen ovale remains completely open - this defect is more clearly visible on ultrasound, and is called atrial septal defect(DMPP). The difference between the oval window and the atrial septal defect is that the oval window has a working valve, and with an atrial septal defect it does not.

An open oval window in the heart of a child is not a defect, but refers to minor anomalies of heart development (MARS), such children from the age of three belong to the second group of health. For conscripts, an open oval window without blood discharge provides for a category of fitness "B", that is, it is fit for military service with minor restrictions.

How to recognize an open foramen ovale?

In most cases, the presence of an open oval window is found out by chance, during examination as part of a medical examination, or if a small defect is suspected with the following symptoms:

in newborns and infants - blue around the mouth (cyanosis of the lips or nasolabial triangle) when coughing, screaming, crying, when emptying the intestines. At rest, the blue disappears;
in older children - low endurance to physical activity, fatigue, unexplained episodes of dizziness and loss of consciousness;
predisposition to frequent colds and inflammatory diseases of the respiratory system.
a murmur is heard in the child's heart.

If a child is suspected of having an open oval window, the pediatrician sends him for a consultation with a cardiologist and echocardiography (ultrasound of the heart, echocardiography). Ultrasound of the heart will allow you to see and recognize the hole in the interatrial septum, as well as the opening flap of the open foramen ovale. In addition, ultrasound can determine how much blood passes through a defect in the interatrial septum, in which direction the blood moves through the heart, and what other anomalies there are in it.

For an open oval window on ultrasound, the following features are characteristic: small size (from 2 to 5 mm, on average 4.5 mm), visualization of the valve in the cavity of the left atrium, location in the middle part of the interatrial septum (in the region of the oval fossa), inconsistent visualization, thinning of the walls of the interatrial septum in the region of the oval window (with a defect in the septum, the edges are thickened).

Treatment of an open oval window

Most often, the presence of an open oval window does not cause any complaints, complications are extremely rare, and treatment is not required. The risk of complications for children and adults with an open foramen ovale presents some specific burdens. In older children, the discharge of blood can occur with paroxysmal coughing, diving, exercises, accompanied by straining and holding the breath. Therefore, such children are contraindicated in scuba diving, deep-sea diving, weightlifting.

At an older age, with conditions that increase right-atrial pressure, it is possible to open the oval window, in particular, during pregnancy, severe pulmonary insufficiency and pulmonary embolism (blockage of the pulmonary artery by blood clots).

If a child or an adult, apart from an open oval window, has no other disturbances in the work of the heart, if he does not suffer from chronic diseases of the veins and lungs, and this hole does not greatly interfere with blood circulation, then there is no reason for concern. In this case, doctors advise only to avoid unnecessary physical exertion and be observed by a cardiologist, periodically repeating an ultrasound of the heart (monitor the size of the hole).

If there is a high risk of thrombosis (formation of blood clots), drugs that prevent the formation of blood clots (anticoagulants) are prescribed.

However, if the hole reaches a significant size, there is a discharge of blood from one atrium to another - surgery may be required. To do this, a catheter (tube) is inserted into the artery, at the tip of which a special device is located, which, when inserted into the oval window, completely clogs it.

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

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

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

Oval window in the heart in children - description

Oval window in the heart in children

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

In particular, in the septum that separates the atria, there is a hole called the oval window. Its presence is due to the fact that the lungs of the fetus do not work, and therefore little blood enters their vessels.

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

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

If the window closes ahead of time, still in utero, it threatens with heart failure and even death of the child, so the presence of a hole is important for the fetus. Closing the window occurs in different children in different ways. In some, the valve grows to it immediately after birth, in others - during the first year, in others - by the age of 5.

In some cases, the size of the valve is insufficient to close the entire oval window, which is why the hole remains slightly open for life, and blood in a small volume is periodically discharged from the small circle into the systemic circulation.

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

With a septal defect, the valve is completely absent and blood can be shunted from left to right, which is a health hazard. Distinguish between an open oval window and other septal defects. The difference is that such a window always has a valve that regulates blood flow.

If there is a defect, the valve is absent, but there is a hole in the septum, which can be seen on ultrasound. The oval window is not considered a heart disease, it is classified as a minor anomaly in the development of the cardiovascular system. In infants, this is not yet a cause for concern, but in older children, the anomaly should not be brought to complications.

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

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

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

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

One of the main functions of the heart is to provide a constant flow of blood in the body (this function is called pumping). This is due to the constant contraction of the muscles of the heart. When the heart muscle contracts, blood from the chambers of the heart is pushed into the vessels that depart from the ventricles of the heart (arteries), and when relaxed, the atria fill with blood that comes from the vessels that flow into the heart (veins).

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

Blood circulation in the fetus occurs differently than in an adult. During the intrauterine period, the so-called "fetal" (fetal) structures in the cardiovascular system function in the baby. These include the foramen ovale, aortic and venous ducts.

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

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

Simply put, pure arterial blood only enters the fetal liver, because in the prenatal period it performs an important hematopoietic function (it is for this reason that the liver occupies most of the baby's abdominal cavity).

Then two streams of mixed blood from the upper and lower parts of the body flow into the right atrium, where, thanks to a functioning foramen ovale, the bulk of the blood enters the left atrium.

The remaining blood enters the pulmonary artery. But the question arises: why? After all, we already know that the pulmonary circulation in the fetus 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 - this is the aortic duct. Through it, the remaining blood is discharged from the small circle to the large one.

Immediately after birth, when the newborn takes its 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. During the first year of life, as a rule, the valve fuses completely on its own 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 communication between the atria can close later. Often cases are recorded when this process is completed only by the age of 5 years.

Appointment of an open oval window

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

The timing of its complete closure is different, but in most children the oval window closes by about a year of age, in some children (not always), it is allowed that the oval window in the heart closes at a later date.
Thus, an open foramen ovale is one of the normal stages in which a child's heart develops.

The human heart normally consists of two parts. Each of them has partitions made of connective tissue. The diagnosis of "open oval window" means that the hole in the septum between the atria has not completely closed. If the open foramen ovale is not present in the fetus, or if it is not sufficiently open, it can lead to fetal death.

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

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

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

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

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

It is noticed that the anomaly is more often observed in premature babies. It is believed that smoking and alcohol or drug abuse by a woman during pregnancy can serve as causes. Other factors:

bad ecology;
heredity;
chemical impact;
stress.

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

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

With the normal development of the newborn, the closure of the valve occurs already in the first 3-5 hours of life. The overgrowth of the window in children is a longer process, requiring from two months to two years. However, there were cases when the window did not overgrow for five years and even throughout life.

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

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

This happens in premature babies, and in those who have been diagnosed with intrauterine developmental pathologies. A defect such as an open oval window in newborns does not refer to heart defects, but to small anomalies in the development of the heart (abbreviated as MARS).

This means that the existing damage does not pose a big threat. People live for years without even suspecting that some kind of malfunction occurs in the heart.

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

How the disease manifests itself

With a small size of the oval window, external manifestations may be absent. Therefore, the severity of non-closure can be judged by the attending physician. For infants with an open oval window, it is typical:

Blue lips, tip of the nose, fingers when crying, straining, coughing (cyanosis);
Paleness of the skin;
Rapid heartbeat in infants.

In adults with pathology, cyanosis of the lips may also appear with:

Physical activity, which is fraught with an increase in pressure in the pulmonary vessels (prolonged breath holding, swimming, diving);
Heavy physical labor (weightlifting, acrobatic gymnastics);
With lung diseases (bronchial asthma, cystic fibrosis, emphysema, lung atelectasis, pneumonia, with a hacking cough);
In the presence of other heart defects.

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

Frequent fainting;
The appearance of cyanosis of the skin even with moderate physical exertion;
Weakness;
dizziness;
The lag of the child in physical development.

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

With an open oval window measuring from 4.5-19 mm or incomplete closure of the valve, a child may experience transient cerebrovascular accidents, signs of hypoxemia and the development of such severe complications as ischemic stroke, kidney infarction, paradoxical embolism and myocardial infarction.

More often, an open oval window 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 a sharp 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);
predisposition of the child to frequent inflammatory diseases of the bronchopulmonary system;
fainting (in severe cases).

When examining while listening to heart sounds, the doctor may register the presence of "noises".

The main diagnostic methods are:

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

When determining the treatment algorithm, the doctor should consider the following indicators:

the age of the child;
health status of a small patient;
accompanying illnesses;
whether there is an allergy to drugs;
are there any contraindications.

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

The following signs should prompt the idea of referring a doctor to a cardiologist:

Under load, cyanosis of the skin in the lip area is manifested.
Until the age of 10, a child may lag behind in development - both physically and mentally.
Children between the ages of 13 and 15 are less hardy than their peers.
Due to poor blood flow and insufficient supply to the organs of the respiratory system, the child develops diseases such as pneumonia, bronchitis.

If a defect is found in a newborn child, therapy is not carried out, no intervention is required.
Echocardiography is the "gold" standard and the most informative method for diagnosing this pathology. The following signs are usually seen:

Unlike ASD, with an open oval window, not the absence of a part of the septum is revealed, but only its wedge-shaped thinning is visible.
Thanks to color Doppler sonography, one can see the "twists" of the blood flow in the area of the oval window, as well as a slight shunt of blood from the right atrium to the left.
With a small size of the foramen ovale, there are no signs of enlargement of the atrial wall, as is typical for ASD.

The most informative is an ultrasound examination of the heart, which is carried out 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 much better visible.

This is due to the anatomical proximity of the esophagus and the heart muscle. The use of this method is especially important in patients with obesity, when visualization of anatomical structures is difficult.

In addition to ultrasound of the heart, other diagnostic methods can be used:

On the electrocardiogram, signs of blockade of the legs of the bundle of His, as well as impaired conduction in the atria, can be detected.
With a large foramen ovale, there may be changes on the chest x-ray (slight atrial enlargement).

Most often, MARS syndrome does not cause any complaints or complications. In these cases, no treatment is required. The risk of complications is represented by some specific loads. In children who are many years old, blood can be discharged when diving, paroxysmal coughing, exercise, which are accompanied by holding the breath, straining.

Such children from year to year should not be engaged in scuba diving, weightlifting and deep-sea diving. Therefore, parents should not worry if their child has PFO, but there are no other heart disorders, chronic diseases, circulatory disturbances, no matter how old he is, everything is going well and the prognosis is favorable.

An open foramen ovale in newborns is not a cause for concern! But for this to be true, doctors advise avoiding serious physical exertion and monitoring your health and doctors. If the risk of blood clots is high, doctors prescribe anticoagulants.

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

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

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

At an older age, you should also not panic, you need a doctor's control, ECG and EchoCG. Cardiologists recommend to undergo an examination every six months.

If the doctor detects the risk of thrombosis, treatment under his supervision is recommended, taking special medications that thin the blood. Also in such cases, doctors advise avoiding excessive stress.
If the hole is larger than normal, surgery may be required. It consists in the introduction of a tube with a special “closer” at the end, which completely removes the gap between the atria.

According to experts, it is necessary to follow the daily routine of the child, nutrition, not to overload him (including in the psycho-emotional plan). In the diet, you should stick to protein foods, eat vegetables and fruits. Also, you can not run any, even the most, at first glance, minor infections. Any failure of the body can potentially affect the work of the heart.

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

pulmonary hypertension;
pathology of the respiratory system;
thromboembolism.

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

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

Blood clots in the blood vessels of the brain can cause a stroke.
If clots accumulate in the coronary vessels, myocardial infarction occurs.
When the arteries of the extremities are blocked, their ischemia occurs, they can die.

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

atrial fibrillation;
aneurysms of blood vessels and heart.

If these factors are present, the patient is prescribed blood-thinning drugs (anticoagulants). The dose and mode of administration is determined in each case individually.

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

They can be prescribed vitamin-mineral complexes, drugs for additional nutrition of the myocardium:

Panangin,
Magne B6,
Elkar,
ubiquinone,
antiplatelet agents (warfarin).

The need to eliminate the open window in newborns is determined by the volume of blood discharged into the left atrium and its effect on hemodynamics. With a slight violation of blood circulation and the absence of concomitant congenital heart defects, surgical treatment is not required.

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

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

Surgical intervention may be required with a large diameter of the oval window with blood flow into the left atrium.
Currently, endovascular surgery is widely used. 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.

Control over the movement of the catheter is carried out using an X-ray machine, as well as an ultrasonic sensor installed through the esophagus. When the region of the oval window is reached, the so-called occluders (or grafts) are passed through the catheter, which are a “patch” that closes the gaping hole.

The only drawback of the method is that the 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 the catheter and opens like an "umbrella" in the atrial cavity. A feature of the patch is the ability to cause tissue regeneration.

After attaching this patch in the region of the opening in the septum, it resolves within 30 days, and the foramen ovale is replaced by the body's own tissues. This technique is highly effective and has already become widespread.

All manipulations are performed endovascularly (also called transcatheter closure). A catheter is installed on the right thigh, through which an occluder is delivered to the heart through the vessels with special tools - a device like an umbrella from both sides. After the occluder opens, the hole is securely sealed and the problem disappears.

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

So, an open oval window found in newborns is not a cause for alarm at all. If the window has not closed after 2-5 years, a cardiologist should be observed and consulted. Discussions about what is the "norm" and what is "pathology" are still ongoing.

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

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

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

In addition, with a heart attack, an open window in the septum between the atria adversely affects the recovery period. Also, adults with an open window are more likely to experience migraines and often experience shortness of breath after getting out of bed, which immediately disappears as soon as the person lies back in bed.

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

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

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

Parents whose children have been diagnosed with an open foramen ovale should follow these guidelines:

Even in the absence of pronounced symptoms, it is necessary to register the child with a cardiologist. The doctor should observe the child regularly.
An open oval window in the heart and sports accompanied by heavy loads are incompatible. Physical exercises should not contain strength exercises and excessive tension of the abdominal muscles.
Keep your child away from running, squatting, jumping, and anything else that could trigger a shunt. It is necessary to properly organize the daily routine in order to balance the periods of activity and rest of the child. You need to include naps in your schedule.
Every 2 hours you need to do a little exercise, stretch your leg muscles to prevent the possibility of developing vein diseases in the future. Pay attention to the positions in which the child is sitting. Teach him to sit with the correct position of the legs: they should not be tucked in and folded crosswise.
The best way to prevent stroke in the future is to lead an active lifestyle to prevent stagnation of blood in the lower extremities and prevent vein diseases.
Experts recommend hardening and general strengthening procedures.
Children with this diagnosis need an annual vacation at the resort and regular walks in the fresh air.
Take care of the sufficient amount of fluid that the child should consume during each day.

Do not let your child notice your concerns about his health - this can lead the baby to panic and an increased nervous background. This will not improve his condition. Be always calm, good-natured and attentive to your child.

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

There are no specific methods for preventing an open foramen ovale. In order for a person not to have a non-closure of the oval window, his pregnant mother needs to lead a healthy lifestyle:

give up smoking and alcohol;
eat rationally and balanced (limit the consumption of fried, spicy, smoked foods, eat more foods high in fiber (vegetables, fruits, greens).

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

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

Any problems with a child's heart frighten parents and cause worries, especially if they are congenital malformations. However, among cardiac pathologies in childhood, there are also very serious, life-threatening, and not so dangerous ones, with which a child can live quite normally. The second also includes an open oval window (abbreviated as LLC).

An open oval window is not such a terrible diagnosis for a child and his parents

What is it

In particular, in the septum that separates the atria, there is a hole called the oval window. Its presence is due to the fact that the lungs of the fetus do not work, and therefore little blood enters their vessels. The volume of blood that in an adult is ejected from the right atrium into the veins of the lungs, in the fetus passes through the hole into the left atrium and is transferred to the more actively working organs of the baby - the brain, kidneys, liver and others.

A small valve separates such a window from the left ventricle, fully maturing by the onset of labor. When the baby takes his first breath and his lungs open, after which blood rushes to them, which is accompanied by an increase in pressure inside the left atrium. At this moment, the oval window is closed by a valve, and then it gradually fuses with the septum. If the window closes ahead of time, still in utero, it threatens with heart failure and even death of the child, so the presence of a hole is important for the fetus.

The window between the atria can close even by 5 years

Closing the window occurs in different children in different ways. In some, the valve grows to it immediately after birth, in others - during the first year, in others - by the age of 5. In some cases, the size of the valve is insufficient to close the entire oval window, which is why the hole remains slightly open for life, and blood in a small volume is periodically discharged from the small circle into the systemic circulation. This situation is observed in 20-30% of children.

A foramen ovale that has not closed completely after birth is not considered a defect in the septum that separates the atria, as the defect is a much more serious problem. It is considered a congenital defect, and LLC is classified as a minor anomaly, representing only an individual feature. With a septal defect, the valve is completely absent and blood can be shunted from left to right, which is a health hazard.

A PDO that does not close over time is a congenital heart disease

The reasons

Most often, an unclosed foramen ovale in a child's heart is associated with a genetic predisposition, which in most cases is transmitted from the mother. Other reasons for the appearance of LLC are adverse effects during gestation:

Bad environmental situation.
Nicotine.
Stress.
Narcotic substances.
Alcohol.
Medicines prohibited during pregnancy.
Malnutrition.

Quite often, the non-closure of the oval window is noted in children who were born much earlier, as well as in the presence of intrauterine growth retardation in full-term babies.

In the next video, you can see how the blood circulation and heart activity of a child should normally change before his birth.

Symptoms

If the open valve is an isolated problem and the child has no other heart defects, the clinical picture is rather poor. You can suspect LLC in a baby by:

Detection of palpitations.
Changes in the color of the nasolabial triangle (it turns blue or gray) during feeding or crying.
shortness of breath.
Bad appetite.
Little weight gain.

Preschoolers and school-aged children may have problems with exercise tolerance and frequent inflammatory diseases of the respiratory system.

A schoolchild with LLC gets tired quickly and needs a strict daily routine with alternating loads and rest

In adolescence, when the body is actively growing and hormonal changes occur, LLC in children manifests itself:

Weakness.
Sensations of interruptions in the heart rhythm.
Increased fatigue.
Episodes of dizziness.
Periodically appearing causeless fainting.

Diagnostics

You can suspect the presence of LLC in a baby after listening to the heart with a stethoscope. If the doctor hears systolic murmurs, he prescribes an ultrasound for the child, since this method is most preferable for detecting the oval window. Pathology is often detected during a routine echocardiography performed in all children at 1 month. In some cases, to clarify the problem, the baby may be prescribed a transesophageal ultrasound, as well as angiography.

Ultrasound signs of an open oval window are:

Size up to 5 mm.
Position in the middle of the septum.
Hole visualization inconsistency.
Detection of a valve in the left atrium.
Thinned interatrial septum.

You can see what LLC looks like on ultrasound in the next video.

Komarovsky's opinion

A well-known pediatrician confirms that the oval window is open in almost all newly born babies and in 50% of them it remains open until the age of 2. But even at the age of 2 to 5 years, the presence of such a window in the heart is considered a variant of the norm, which practically does not affect the well-being and health of the child.

Komarovsky emphasizes that this is not a heart defect and in most children the window closes on its own in the first years of life without any intervention from doctors.

Treatment

If there is no pronounced clinic and problems with the work of the heart, which is especially common in the presence of PFO, no medical treatment is required. The child is recommended measures that are important for the overall strengthening of the body:

Walks in the open air.
Balanced diet.
Proper distribution of loads and rest during the day.
hardening procedures.
Physiotherapy.

If there are complaints from the heart, children are prescribed drugs for myocardial nutrition and vitamins. Most often, babies are prescribed l-carnitine, ubiquinone, panangin and Magne B6.

The most effective treatment for PFO is the insertion of a patch into the right atrium.

If PFO is combined with other defects, the child is treated by a cardiac surgeon, since surgery is often required. One of the effective measures with an open oval window is the introduction of a probe with a patch into the child's femoral vein. When the probe reaches the right atrium, the patch is applied to the window and closes it. While it will resolve within a month, the processes of formation of connective tissue are activated in the septum, as a result of which the oval window closes.

Forecast

Many parents worry that a "hole in the heart", as they call LLC, will threaten the child's life. In fact, such a problem is not dangerous for the baby, and most children with an open window feel quite healthy. It is only important to remember some restrictions, for example, in relation to extreme sports or professions in which the load on the body increases. It is also important to examine the baby every 6 months with a cardiologist with an ultrasound study.

If the foramen ovale remains open after the child's fifth birthday, it is most likely that it will no longer close and the child will have it for the rest of his life. At the same time, such an anomaly has almost no effect on labor activity. It will become an obstacle only for obtaining the profession of a diver, pilot or astronaut, as well as for strong sports activities, for example, weightlifting or wrestling. At school, the child will be assigned to the second health group, and when a boy with LLC is called up, they will be counted as category B (there are restrictions in military service).

Many children with LLC feel quite healthy.

It is noted that at the age of over 40-50 years, the presence of PFO contributes to the development of coronary and hypertension disease. In addition, with a heart attack, an open window in the septum between the atria adversely affects the recovery period. Also, adults with an open window are more likely to experience migraines and often experience shortness of breath after getting out of bed, which immediately disappears as soon as the person lies back in bed.

Among the rare complications of PFO in childhood, embolism may occur. This is the name given to the entry into the bloodstream of gas bubbles, particles of adipose tissue or blood clots, for example, in injuries, fractures or thrombophlebitis. When emboli enter the left atrium, they travel to blood vessels in the brain and cause brain damage, sometimes fatal.

It happens that the presence of an uncovered foramen ovale helps to improve health. This is observed in primary pulmonary hypertension, in which, due to high pressure in the vessels of the lungs, shortness of breath, weakness, chronic cough, dizziness, and fainting occur. Through the oval window, blood from the small circle partially passes into the large one and the vessels of the lungs are unloaded.

You can learn more about the open oval window from the following video.

Article publication date: 02/10/2017

Article last updated: 12/18/2018

From this article you will learn: in which cases an open oval window in the heart of a child is a variant of the norm, and in which cases it is a heart defect. What happens with this condition, can it be in an adult. Methods of treatment and prognosis.

The foramen ovale is a canal (hole, passage) in the region 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 be closed (overgrown), as it becomes unnecessary.

If overgrowth does not occur, this condition is called an open oval window. 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 must be thrown out from the right half of the heart to saturate it with oxygen, but immediately, having got into the left parts of the heart, it spreads throughout the body. This 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 a year, this channel should be closed.
The presence of a small open area of the oval window in children aged 1–2 years is 50%. If at the same time there are no manifestations of the disease, this is a variant of the norm.
If a child has symptoms in the first year of life, and if the oval window functions in children older than 2 years, this is a pathology - a small anomaly in the development of the heart.
For adults and children over 2 years of age, the window must be closed. But under certain circumstances, at any age, it can open, even if overgrown in the first year of life - this is always a pathology.

This problem is curable. The treatment is carried out by cardiologists and cardiac surgeons.

What is an open oval window for?

The heart of a fetus in the womb beats regularly and provides blood circulation to all organs except the lungs. Oxygenated blood flows to 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 the formed heart. Therefore, the circulation of blood in the fetus occurs bypassing the lungs.

For this, the oval window is intended, which dumps 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 from the side of the left atrium. Therefore, the oval window is able to provide only one-way connection between them - only the right with the left.

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

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

The oval window is an important structure that provides blood circulation to the fetus in the prenatal period. But after the birth of a child, it should not function and gradually overgrow.

Possible development of pathology

By the time of birth, the lungs of the fetus are well developed. As soon as a newborn baby takes the first breath and they are filled with oxygen, the pulmonary vessels open and blood circulation starts. From that 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 overgrow (close).

When this happens - the process of overgrowing

The process of closing the oval window proceeds gradually. In every newborn, it can periodically or constantly function. But due to the fact that after birth the pressure in the left cavities of the heart is much higher than in the right ones, 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 to reduce pressure in the right atrium. The lower it is compared to the left one, the tighter the valve will be pressed, which should firmly fix (grow together 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 have no complaints, this is not considered abnormal, but requires observation, and by two years it should completely close. Otherwise, it is regarded as a pathology.

adults

Normally, in children older than two years and in adults, the foramen ovale should be closed. But in 20% it either never overgrows, or re-opens throughout life (and then it is from 4 to 15 mm.

Six reasons for the problem

Six main reasons why the foramen ovale does not close or open:

Harmful effects on the fetus (radiation, toxic substances, medications, intrauterine hypoxia and other complicated variants of the course of pregnancy).
Genetic predisposition (heredity).
Prematurity.
Underdevelopment (dysplasia) of connective tissue and heart defects.
Severe broncho-pulmonary diseases and pulmonary embolism.
Constant physical exertion (for example, crying or coughing for young children, strenuous exercise and sports for adults).

Pathological signs and symptoms

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

About 70% of people with an open channel have no complaints. This is due to the small size of the defect (less than 3–4 mm).

How the problem is diagnosed

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

Image of a large open foramen ovale during an ultrasound of the heart. Click on photo to enlarge

Treatment

In deciding whether treatment is necessary and choosing the optimal method, two factors are taken into account:

Are there any symptoms or complications?

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

What are the dimensions of the defect and the magnitude of the discharge of blood 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, an operation is indicated.

The oval window is easily closed with the help, which is performed without a single incision through the puncture of one of the large arteries.

Endovascular surgery to close the foramen ovale in the heart

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% of cases, when unfavorable circumstances are added to this anomaly (diseases of the lungs, heart, 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 an open foramen ovale should visit a cardiologist once a year and undergo an ultrasound of the heart.

Such a diagnosis as an open oval window has become a fairly common finding, due to the widespread introduction of ultrasound diagnostic methods into practice, in particular, ultrasound of the heart. This phenomenon can be detected both in childhood and in adulthood, but when it is a pathology, and when it is not, it remains to be seen from the article.

Open oval window: normal variant

The adult heart has 4 chambers: 2 ventricles and 2 atria. Moreover, the right and left chambers are separated by partitions: interventricular and interatrial, which prevent blood from mixing from one part of the heart with another.

The foramen ovale is essentially an opening (hole) between the two atria. But is the situation when the oval window can function always a manifestation of pathology? During the period of intrauterine development of the fetus, a functioning oval window is the absolute norm.

The fetus, while in the womb, receives nutrients and breathes through the umbilical cord. The lungs in a developing child do not function, so the pulmonary circulation, which starts from the right ventricle and ends in the left atrium (LA), does not work. In order for only a small part of the blood to enter the lungs, part of it is dumped from the right into the left atrium. This is the main function of the LLC (open oval window).

Thus, the blood that flows into the RA (right atrium), through a functioning open foramen ovale, flows partially into the left atrium. It is important to note that the reverse flow of blood is impossible, because. an open oval window in the body in children has a valve that prevents this.

At the time of the birth of a child with his first breath, the pulmonary circulation begins its work. The function of an open window in the heart, which was previously necessary, is no longer needed. In the LA (left atrium), the pressure in a person is normally slightly higher than in the right one, therefore, when blood enters it from the pulmonary veins, it seems to press on the valve of the open oval window in children, predisposing to its rapid overgrowth.

Unclosed foramen ovale in childhood

An open oval window in newborns is the absolute norm. It does not close immediately, but gradually. This happens due to the growth of the window valve to its edges. Usually within a period of 3-4 months to 2 years, an unclosed window is no longer detected. For some, it can remain open for up to 5 years, which is also not a pathology. Thus, neither in a newborn nor in a baby, an open oval window is a pathology.

If the oval window did not close even later, then this can be detected by ultrasound of the heart, then this pathology is called, or MARS, which is not a true defect.

The reasons

To date, there are many assumptions about the reasons that may lead to a situation where the open oval window in the heart of a child does not close. Here are the most common ones:

hereditary predisposition - probably due to the fact that the valve of the oval window has a smaller diameter, which does not allow it to close;
the presence of a VPS (), most often these are defects in the mitral, tricuspid valves and an open ductus arteriosus;
prematurity;
connective tissue dysplasia;
smoking, taking alcohol and drugs by the mother during the period of bearing a child;
the impact on the body of a pregnant woman of harmful environmental factors.

Hemodynamics

Since the foramen ovale, located on the oval fossa in the region of its bottom, has a valvular structure, the flow of blood from the LA to the RA becomes almost impossible, despite the difference in pressure. For the most part, this small anomaly in the heart does not lead to hemodynamic disturbance. However, in cases where, for certain reasons, there is increased pressure in the right atrium (pregnancy, severe respiratory disorders), it is possible to shunt the blood from right to left. As a result of this, less blood enters the ICC (pulmonary circulation), oxygen deficiency of lung tissues develops, as well as blockage of vital organs by emboli and blood clots: heart, brain, kidneys with the development, respectively, of stroke and kidney infarction

Symptoms in children and adults

Signs of an open foramen ovale in young children are usually subtle and non-specific. Parents can pay attention to such manifestations in infants:

during feeding, screaming, when straining or coughing, the baby's nasolabial triangle acquires a bluish tint;
the presence of shortness of breath in the same situations (crying, feeding, etc.);
frequent heartbeat;
refusal to eat;
low weight gain, delayed physical development.

An open foramen ovale in the heart in adolescents and adults also usually does not interfere with human life and has an asymptomatic or oligosymptomatic course.

Pathology can be suspected by indirect symptoms similar to those that:

cyanosis or blanching of the nasolabial triangle, which occurs against the background of physical exertion;
some symptoms of pulmonary insufficiency (shortness of breath, rapid pulse);
low tolerance of physical activity (the appearance of rapid fatigue during their performance);
predisposition to diseases of the respiratory system (ARVI, bronchitis, pneumonia);
fainting;
headaches, including migraine-like;
violation of cerebral circulation (very rarely - with paradoxical embolism in persons suffering from varicose veins and thrombophlebitis of the lower extremities).

Diagnostics

The diagnosis can be made on the basis of the following data:

Examination that includes listening to the heart: in this case, the doctor will hear a heart murmur, which occurs due to improper reflux of blood.
Electrocardiography: In adults, signs of right atrial/ventricular overload may be observed.
Chest X-ray, in which you can also indirectly see right atrial overload, which will appear as an expansion of the shadow of the heart to the right.
Doppler ultrasound of the heart: this method is the most informative. Signs of an open oval window will be:

hole dimensions about 4.5 mm (may vary from 2 mm to 5 mm);
oval window valve, which is visualized in the left atrium;
the interatrial septum is thinner in the area where the oval window is located;
the defect is not always visible.

For more accurate information and visualization of the oval window, it is recommended to perform transesophageal echocardiography in adolescents, as well as in adults.

Angiography: an invasive technique that allows you to look "from the inside" the state of the vessels. It is performed according to strict indications in a hospital setting.

Treatment

If the presence of an open oval window does not have subjective complaints and manifestations, then neither children nor adults require special therapy. It is recommended to perform an annual cardiac ultrasound to monitor the size of the window and blood reflux. Also for such patients give general recommendations on lifestyle:

limitation of excessive physical activity;
avoiding sports such as diving, weightlifting, scuba diving, diving;
performance of physiotherapy exercises;
balanced diet;
correct work/rest schedule.

If there are no symptoms, but there are risk factors (a history of an episode of ischemic attacks of the brain, the presence of varicose veins), then it is advisable for such patients to use anticoagulants (warfarin) and antiaggregants (cardiomagnyl).

The situation when the discharge of blood from the right atrium to the left has become significant, there has been a serious overload of the right atrium, surgical treatment is indicated. This surgery is performed through the femoral vessel under x-ray control. A catheter is inserted through the vein, at the end of which there is an occluder device. Bringing it to the area of the open oval window, the occluder completely closes the hole.

The appearance of the occluder for the operation for the complete closure of LLC

Thus, an open foramen ovale is not a heart defect and most often does not pose a serious threat to life and its quality in a patient. However, it is still worth it to undergo regular examination by a cardiologist and perform echocardiography, because. with a large hole diameter and the presence of concomitant factors, dangerous complications can develop.