Open foramen ovale 5 mm. An open foramen ovale was detected in a child or an adult: the causes of its appearance, diagnosis, treatment, important questions for patients

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 (FOO). 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 rise to 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 won 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.

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 recess 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 hole. 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 you need to undergo routine examinations and carry out prevention with the help of medications or traditional medicine.

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), shunting of blood from right to left is possible. 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:

1. 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.
2. Electrocardiography: In adults, signs of right atrial/ventricular overload may be observed.
3. 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.
4. 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.

1. 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.

If the baby is healthy and cheerful, he plays, eats well and grows. The time comes for a scheduled visit to the pediatrician, and suddenly the diagnosis is an open oval window. First, panic and worries, then the understanding that this is not the worst disease - you can live a full life with it, but with few restrictions.

Sometimes a mother finds out about her baby's open oval "window" while he is still a baby. It is important to understand that this is not a sentence, but a structural feature of the organ, which in certain cases requires treatment. The kid needs to be helped to accept his condition and peculiarity and try not to put too much pressure on him.

An open foramen ovale is not considered a heart defect and you can live with it.

What is an open foramen ovale in the heart?

In the womb, the fetus grows and develops. The following changes occur with the heart, which are of such great importance for its further development:

1. Between the left and right atrium, the unborn baby has a small "hole" - this is a variant of the norm. When its size is insufficient, or it is absent, the death of the baby before his birth is possible.
2. A valve is formed from the left atrium.
3. At the moment of birth, the valve is closed by the pressure created from the baby's first cry.
4. The valve adheres to the wall of the atrial septum, isolating the right atrium from the left.

Sometimes the valve does not have time to form, and its size is too small to isolate the right and left atrium - the open oval window in the heart does not overgrow. And now, when the heart is working, blood will flow from one atrium to another. Such a newborn is diagnosed with a "minor anomaly of heart development" (MARS).

An open oval window is not a vice, you do not need to overly protect the child and deprive him of the opportunity to explore the world. If the hole does not close immediately, there is no need to worry and limit the baby - it may close later.

Norms of LLC sizes in newborns

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There are general normative indicators for the size of an open oval window. It is important to understand that the presence of pathology can only be determined by a doctor after a comprehensive examination. The main indicators of the norm:

• when diagnosed using ultrasound, the size of the hole between the left and right atrium is up to 2 mm;
• with contrast echocardiography - with this ultrasound method, during intravenous administration of shaken saline, microscopic bubbles should not enter the left atrium from the right;
• with echocardiography through the esophagus, the size of the gap between the two atria is up to 2 mm;
• on chest x-ray - the absence of extensions of the shadow of the heart on the right side.

These indicators are subjective, each organism is individual, and it is possible to make a diagnosis or talk about the likelihood of surgical intervention only after a thorough examination.

The primary task is to do an ultrasound and x-ray, consult with several doctors and develop a set of measures to improve the condition of your baby.

At what age should the foramen ovale close completely?

In half of newborns, the oval window in the heart closes in the first year of life, usually not earlier than 3 months after birth, less often the process stretches up to 5 years. There are cases when a closed oval window opens under the influence of negative factors at an older age. Many children with an open oval window feel comfortable and lead an active life.

In 1930, a study was conducted during which the activity of thousands of children's hearts was studied, of which 350 were found to have an open foramen ovale. According to the results of a recent study, this number has already increased by 40%, which is also facilitated by poor ecology.

When can it be considered a pathology?

There is a significant difference between the structural features of the heart and its pathology. Deserves special attention and careful medical supervision of a child whose heart window size is more than 2 mm.

What is considered a pathology? The list of characteristic symptoms in children from 0 to 7 years:

• murmurs in the heart;
• frequent intermittent breathing;
• cardiopalmus;
• inertness and lethargy of the baby, weakness and fatigue;
• slow development;
• severe headaches, dizziness;
• fainting, especially with a lack of oxygen;
• blue skin on the face in the region of the nasolabial triangle.

Causes of untimely closure of the oval window

The main factor influencing the occurrence of heart pathology in the form of an open gap between the right and left atrium is the features of intrauterine development. Doctors do not just talk about the dangers of alcohol during pregnancy, and packs of cigarettes are full of appropriate warnings.

Pregnancy is a responsibility, and in many cases it depends on the expectant mother whether her baby will be healthy or he will have to face difficulties.

Reasons for untimely closure of the oval window:

1. Abuse of pregnant women with alcohol and cigarettes.
2. Interaction with toxic, harmful substances.
3. Bad ecology.
4. Experiences and stresses of the expectant mother.
5. Negative effects of medications during fetal development.
6. Heredity, genetic predisposition. An open foramen ovale in a child's heart does not match the size of the valve. The baby will grow, and the discrepancy in the heart will increase.
7. The newborn was born prematurely (early). An open oval window in newborns is the norm, but if the baby was not born on time, then the organ has not yet formed, and there is a risk that the hole in the heart does not meet the standard value of 2 mm.
8. Violent cough caused by diseases of the respiratory tract and lungs. From coughing and pressure, the gap does not close, but may increase in size.
9. Active physical activity. By increasing the load on the heart, especially if it was preceded by recent diseases, the ejection of blood from one atrium to another increases. Under load, the pressure increases, and the gap between the left and right atrium expands.
10. Other heart disease (eg, patent ductus arteriosus, mitral or tricuspid valve disease).
11. The disproportionate growth of the child and the valve of his heart, causing the "hole" between the left and right atrium to increase.

What is dangerous pathology?

The risk of developing pathology for the baby is small - complications in the activity of the heart usually appear either in utero or immediately after birth. At a younger age, doctors are in no hurry to diagnose complications - the individual characteristics of such a complex organ allow you to wait until the age of 5 years before seriously starting to worry.

A "hole" in the child's heart between both atria causes hypertension, if it is large, then complications and disturbances in the activity of the child's body are possible:

1. Thrombus formation. The clot in the cavity of the heart enlarges and breaks away from the walls of the vessel, which leads to blockage of the blood vessels.
2. Circulatory disorders of the brain. They are provoked by hypertension due to an open foramen ovale.
3. A heart attack is a consequence of circulatory disorders, thrombosis and lack of oxygen. Manifested in the necrosis of the body.
4. A stroke is a form of acute disturbance of the blood flow of the brain, a broader concept of a heart attack.

Features of treatment and prognosis

In the absence of pathology, there is usually no need for drug treatment - try not to give the child a strong physical load, treat acute respiratory viral infections and acute respiratory infections in a timely manner, with concomitant heart diseases, therapy and medical supervision are required. While the peculiarity of the baby's body is not recognized as a pathology, it is necessary to reduce the risk of concomitant diseases and factors that could provoke this.

If the size of the oval window in a child exceeds 4 mm, this is a reason for a thorough examination. In cases where it is more than 9 mm, and the blood ejection exceeds the norm, an operation using an endovascular technique is indicated, which includes the following steps:

• a special catheter is inserted through the femoral artery;
• exercising control with the help of ultrasound and ECG, the sashes are glued together, and the hole of the oval window is closed with a special patch;
• the catheter is carefully withdrawn;
• the patch remaining inside fastens the gap between the valve and the septum;
• the patch dissolves;
• within 6 months, antiviral treatment is carried out - a course of antibiotics is prescribed.

This method is efficient and effective, it will allow the child to lead a full active life. Special care is required during the first month after the procedure. For the first six months after the operation, physical rest is necessary, it is necessary to exclude the possibility of viral diseases, to avoid visiting public places. It is necessary to provide a small patient with psychological support and be attentive to him, preventing stress and unrest.

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, this same oval window exists between the two atria, 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.