Open foramen ovale in the heart. If a newborn has an open foramen ovale in the heart, a pediatric cardiologist explains. Complications and prevention

Open oval window most often is anatomical feature. Thousands of people live, work, and give birth to children, despite such a diagnosis. And some, until a certain point, do not even suspect that they have such a defect. Our four-chambered heart consists of two atria and two ventricles. They communicate through special holes. There is a solid septum between the atria that does not allow blood to flow from the left to the right. But sometimes the septum is not completely healed and a gap is formed - an open oval window (OPF). In 30% of the adult population, this defect occurs in the form of a canal or shunt, causing a violation in cardiovascular systems e, lungs due to the difference in blood pressure.

Why does it appear?

At the birth of a child, the lungs expand, pulmonary blood flow increases, pressure in the left atrium increases and promotes the closure of the oval window. Physiological closure does not occur with prematurity, alcoholic embryopathy, or connective tissue dysplasia.

According to some assumptions, the reasons for abnormal development may be the woman’s consumption of alcohol during pregnancy, as well as smoking, ecology, drug use, heredity, and fetal malformations.

LLC can occur with congenital heart disease, when the atrium chambers are stretched.

A patent foramen ovale in the heart is diagnosed in adults and children based on the results of an ECG, X-ray, contrast echocardiography, or by listening to rhythms with a phonendoscope.

Signs and symptoms

There are practically no specific manifestations in adults. The doctor can only suspect that the patient has this disease. An adult may complain of severe headaches, but not everyone has them. Most often, the disease is detected incidentally during other examinations or when complications occur.

But there are symptoms of an open oval window, according to which a preliminary diagnosis is established:

• Blue discoloration of the nasolabial triangle or lips when coughing or physical activity (cyanosis);
• Predisposition to acute respiratory infections and respiratory diseases (frequent bronchitis, pneumonia, asthma);
• Unexplained fainting, thrombophlebitis, varicose veins, cerebrovascular accident;
• Physical intolerance stress, respiratory failure, discomfort;
• Rapid heartbeat, shortness of breath, headaches (migraines);
• The mobility of body parts is impaired, periodic numbness of the limbs;
• The ECG shows changes in the right atrium;
• Increased blood volume in the lungs.

Why is it dangerous?

Typically, a patent foramen ovale in the heart in adults does not affect their activity or life expectancy. But it is dangerous during pregnancy, as well as for people with varicose veins, pulmonary diseases, thrombophlebitis.

Due to PFO, the risk of blood clots in the heart increases and the likelihood of certain complications increases:

• Stroke. Wherein serious illness parts of the brain die;
• Myocardial infarction. With such a disruption of the heart, a section of muscle tissue dies;
• Kidney infarction. Due to impaired blood supply, a section of the kidney dies;
• Impaired blood supply to parts of the brain. A person’s speech and memory are impaired, arms and legs become numb, mobility is impaired and other symptoms that last no more than a day, then disappear without a trace.

Any treatment for an open oval window will not reduce the risk of these complications.

How to treat?

In most cases, treatment for a patent oval window is not required. According to statistics, 10-15% of people live with an LLC and do not experience any inconvenience. When symptoms of an open oval window do not appear, no treatment is prescribed.

If complications of the disease appear, then medications are prescribed to prevent thrombus formation in the heart or blood vessels.

If the hole reaches a significant size, it is possible surgical intervention. Usually, to close it, grafts are inserted - permanent “patches”. But they can cause tissue inflammation. Relatively recently, they began to use an absorbable patch. Although it is a temporary “patch” that dissolves within a month, it effectively stimulates tissue restoration. Thus, the hole is completely closed.

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

Find the answer

This pathology affects 1/2 of the population who live a normal life and are not aware of its presence.

Classification of cardiac pathology

Pathology is classified by size, measured in millimeters:

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

Reasons for a window not closing

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

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

How should it close?

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

With increasing pressure in the blood vessels of the lungs, the functionality of this hole becomes unclaimed.

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

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Problems in an adult

An adult whose age does not exceed 40 years, in the absence of diseases of the cardiovascular system, the presence of an open foramen ovale in the heart area does not interfere with leading a full life.

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

The presence of a disorder in athletes

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

When performing tasks, this pathology may manifest itself as the following symptoms:

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

If these symptoms are detected, you must immediately consult a doctor to full examination and appointments drug treatment.

One of the methods is surgical intervention. The ability to remain in professional sports should only be decided by a doctor, based on the diagnostic results.

Since the presence of this pathology can lead to the formation of blood clots in the heart area, this is fraught with the development of the following series of diseases, which, if medical care is not provided in time, can lead to death:

• myocardial infarction;
• stroke;
• kidney infarction.

Signs and manifestations of pathology

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

Signs of an open window in childhood the following:

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

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

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

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

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

Functioning heart problem

Preservation of the function of the oval window in cases of a measured life rhythm associated with the lack of frequent physical activity, poses no danger.

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

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

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

Of course, you can live a full life with this pathology. But everyone needs to be diagnosed for its presence.

Treatment options

It should be said that this is a pathology in which there is a gap between the right and left atria. It may cause visible symptoms, such as pale skin, blue lips, hands and feet, frequent dizziness, loss of consciousness, as well as a predisposition to frequent colds.

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

However, it can also occur without any symptoms, in which case treatment is not necessary.

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

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

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

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

The operation and the use of the described drugs are used to treat both adults and children.

Help from folk remedies

Unfortunately, folk remedies from this pathology has not yet been identified.

If a person does not have obvious disorders in the functioning of the cardiovascular system, then doctors give him advice on how to lead a lifestyle, and may also prescribe some vitamins and proper nutrition, helping to support heart function. It is also recommended to limit physical activity. But medications are not prescribed to the patient in the absence of symptoms; they can only prescribe measures to strengthen the body, for example, hardening, exercise therapy, and sanatorium-resort treatment.

But if the patient has minor complaints about the heart, the doctor sometimes prescribes special fortified medications that strengthen the cardiovascular system, such as Panangin, Magne B6, Elkar, Ubiquinone, etc. And in case of severe disturbances in the functioning of the cardiovascular system, it is used general therapy the described drugs or perform surgery.

Nutrition rules

In addition to drug treatment, you need to maintain proper nutrition. All people with such a difficult disease must adhere to a strict diet.

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

Below is sample menu with 5 meals a day:

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

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

Possible complications and prognosis

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

From this unusual structure heart problems sometimes occur the following:

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

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

Almost always, the prognosis for people with this diagnosis is not very dire, and ends without complications at all.

People with this pathology should always follow the following recommendations:

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

TO surgical operation come only in the most emergency situations, during pronounced changes in the performance of the cardiovascular and respiratory systems.

And in conclusion, we can add that an open oval window is a pathology that does not cause much harm to health, unless there is a risk of heart disease or some other heart disease. This depends on numerous factors.

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 children’s hearts is open.

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

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

Oval window in the heart in children - description

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

In particular, in the septum separating the atria there is an opening called the oval window. Its presence is due to the fact that the fetal lungs 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. This window is separated from the left ventricle by a small valve that matures completely by the beginning of labor.

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

If the window closes prematurely, while still in utero, this threatens heart failure and even the death of the child, so the presence of an opening is important for the fetus. Closing the window occurs differently for different children. 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 not sufficient to close the entire oval window, which is why the hole remains slightly open for life, and a small volume of blood is periodically discharged from the small circle into the big circle blood circulation

This situation is observed in 20-30% of children. A foramen ovale that does not close completely after birth is not considered a defect in the septum that divides the atria, since 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 discharged from left to right, which poses a health hazard. There are open foramen ovale 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 is visible during ultrasound examination. The oval window is not considered a heart defect; 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 lead to complications.

A serious complication is the so-called “paradoxical embolism” in the case of prolonged non-closure of the window. Emboli are small blood clots, bacteria, even bubbles leaking from venous blood into the arterial through the window.

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

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

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

One of the main functions of the heart is to ensure a constant flow of blood in the body (this function is called pumping). This occurs due to the constant contraction of the heart muscles. When the heart muscle contracts, blood from the chambers of the heart is pushed into the vessels that extend from the ventricles of the heart (arteries), and when it relaxes, the atria are filled 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) sections do not communicate with each other. The atria are divided by the interatrial septum, and the ventricles by the interventricular septum.

Blood circulation in a fetus occurs differently than in an adult. During the prenatal period, the baby has so-called “fetal” (fetal) structures in the cardiovascular system. These include the oval window, the aortic and venous ducts.

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

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

In other words, clean arterial blood gets only to the fetal liver, because in the prenatal period it carries out an important hematopoietic function (it is for this reason that the liver occupies most of the abdominal cavity in the baby).

• The two streams of mixed blood from the upper and lower torso then flow into the right atrium, where, thanks to the functioning foramen ovale, the bulk of the blood flows into the left atrium.

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

Immediately after birth, when the newborn takes his first breath, the pressure in the pulmonary vessels increases. As a result, the main role of the oval window to dump blood into the left half of the heart is leveled out. During the first year of life, as a rule, the valve completely independently fuses with the walls of the hole.

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

Purpose of an open oval window

The baby's heart develops in utero in such a way 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 fetal heart. When the 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 oval window in the heart begins to gradually close.

The timing of its complete closure varies, but in most children the oval window closes by about a year of age; in some children (not always), it is allowed for the oval window in the heart to close at more late dates.
Thus, a patent foramen ovale is one of the normal stages in which a baby's heart develops.

The human heart normally consists of two parts. Each of them has partitions made of connective tissue. The diagnosis of “patent foramen ovale” means that the hole in the septum between the atria has not completely closed. If the fetus does not have a patent foramen ovale or is not open enough, this can lead to intrauterine death.

Even if it was possible to survive in the womb of the mother, the child dies after birth, less often he develops right ventricular heart failure. Every newborn is born with a patent 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, and 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 environmental condition environment;
• hereditary predisposition to diseases of the cardiovascular system;
• exposure to chemicals on the body of a pregnant woman;
• frequent stress and instability psycho-emotional state mother of a child during pregnancy.

It is believed that the highest chances of developing an anomaly are in children whose mothers abused alcohol or alcohol during pregnancy and breastfeeding. narcotic substances. U healthy child The window is closed with a valve. This process happens slowly.

If as a result 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 a child nevertheless develops this anomaly, most likely it will not be possible to get rid of it, but there is no need for this, because an open oval window in the heart in children has almost no effect on their life.

It has been noted that the anomaly is more often observed in premature infants. There is an opinion that the reasons may be smoking and abuse of alcohol or drugs by a woman during pregnancy. Other factors:

• bad ecology;
• heredity;
• chemical exposure;
• stress.

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

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

With normal development of a newborn, valve closure occurs already in the first 3 to 5 hours of life. Overgrowing of a window in children is a longer process, requiring from two months to two years. However, there have been cases where the window did not become overgrown for five years and even throughout life.

So a baby’s window is not yet a reason for concern and immediate treatment. It has been proven that an 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 old.

But what to do if the window has not closed, and by the age of 5-10 years 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 a patent foramen ovale in newborns does not refer to heart defects, but to minor anomalies of cardiac development (abbreviated MARS).

This means that the existing damage does not pose a major threat. People live for years without even suspecting that something is wrong with their hearts.

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

How does the disease manifest itself?

For a small oval window external manifestations may be missing. Therefore, the attending physician can judge the severity of the nonunion. For children infancy with an open oval window it is characteristic:

1. Blue lips, tip of the nose, fingers when crying, straining, coughing (cyanosis);
2. Paleness of the skin;
3. Increased heart rate in infants.

Adults with pathology may also experience bluish lips with:

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

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

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

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

With an open foramen ovale ranging in size from 4.5-19 mm or incomplete closure by the valve, the child may experience transient cerebrovascular accidents, signs of hypoxemia and the development of such severe complications as ischemic stroke, renal infarction, paradoxical embolism and myocardial infarction.

More often, a patent foramen ovale in newborns is asymptomatic or accompanied by mild symptoms. Indirect signs This anomaly in the structure of the heart, by which parents may suspect its presence, can be:

• the appearance of severe pallor or cyanosis during strong crying, screaming, straining or bathing the child;
• restlessness or lethargy during feeding;
• poor weight gain and poor appetite;
• fatigue with signs of heart failure (shortness of breath, increased heart rate);
• the child's predisposition to frequent inflammatory diseases bronchopulmonary system;
• fainting (in severe cases).

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

The main diagnostic techniques 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 decides whether to simply monitor the condition of the heart or prescribe therapy.

When determining a treatment algorithm, the doctor must take into account the following indicators:

• age of the child;
• the health status of the little patient;
• accompanying illnesses;
• are there any allergies to drugs;
• are there any contraindications?

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

The following signs should prompt you to consider referring a doctor to a cardiologist:

1. Cyanosis appears during exercise skin in the lip area.
2. Up to 10 years of age, a child may be behind in development, both physically and mentally.
3. Children aged 13 to 15 years are less resilient than their peers.
4. Due to poor blood flow and insufficient supply to organs respiratory system The child develops diseases such as pneumonia and bronchitis.

If the defect is found in a newborn child, no therapy is carried out and no intervention is required.
Echocardiography is the “gold” standard and the most informative method for diagnosing this pathology. The following signs are usually detected:

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

The most informative is ultrasonography heart test, conducted not through the chest, but so-called transesophageal echocardiography. At this study An ultrasound probe is inserted into the esophagus, as a result of which all the structures of the heart are visible much better.

This is explained by the anatomical proximity of the esophagus and the heart muscle. The use of this method is especially relevant for obese patients, when visualization of anatomical structures is difficult.

In addition to cardiac ultrasound, other diagnostic methods can be used:

• An electrocardiogram may show signs of bundle branch block, as well as conduction disturbances in the atria.
• With a large foramen ovale, changes in the chest x-ray are possible (slight enlargement of the atria).

Most often, MARS syndrome does not cause any complaints or complications. In these cases, no treatment is required. Some specific loads pose a risk of complications. In children who are many years old, blood may be shed when diving, paroxysmal cough, exercises that are accompanied by holding your breath and straining.

Such children should not be exposed to scuba diving, weightlifting, or deep-sea diving year after year. Therefore, parents should not worry if their child has a PFO, but there are no other heart disorders, chronic diseases, interference with blood circulation, no matter how old he is, everything is going well and the prognosis is favorable.

A patent foramen ovale in newborns is not a cause for concern! But for this to really be the case, doctors advise avoiding serious physical activity 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 blood is discharged from one atrium to another, surgery may be prescribed. It is based on inserting a catheter into the artery. At its end there is a special device that completely covers the oval window.

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

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

At an older age, you should also not panic; medical supervision, ECG and EchoCG are necessary. Cardiologists recommend being examined every six months.

• If the doctor detects a risk of blood clots, treatment under his supervision and the use of special blood thinning medications are recommended. also in similar cases Doctors advise avoiding excessive exercise.
• If the hole size is larger than normal, it may be necessary surgery. It consists of inserting a tube with a special “closer” at the end, which completely removes the lumen between the atria.

According to experts, you need to monitor the child’s daily routine, nutrition, and not overload him (including psycho-emotionally). You should stick to protein foods in your diet, eat vegetables and fruits. You should also not run any infections, even the most seemingly insignificant ones. Any malfunction in the body can potentially affect the functioning of the heart.

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

• pulmonary hypertension;
• pathologies of the respiratory system;
• thromboembolism.

Thromboembolism poses 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 get into pulmonary artery, they are distributed throughout all internal organs:

1. Blood clots entering the brain vessels can cause a stroke.
2. If clots accumulate in coronary vessels, myocardial infarction occurs.
3. When the arteries of the limbs become blocked, ischemia occurs and they can die.

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

• atrial fibrillation;
• aneurysms of blood vessels and heart.

If these factors are present, the patient is prescribed blood thinning medications (anticoagulants). The dose and regimen are 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, tremors, convulsions, fainting) and, if necessary, the prevention of paradoxical embolism.

They may be prescribed vitamin-mineral complexes and drugs for additional nutrition of the myocardium:

• Panangin,
• Magne B6,
• Elkar,
• Ubiquinone,
• antiplatelet agents (Warfarin).

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

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

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

Surgery may be required if the oval window has a large diameter with blood flowing into the left atrium.
Currently, endovascular surgery has become widespread. The essence of the intervention is that a thin catheter is installed through the femoral vein, which is passed through the vascular network to the right atrium.

The movement of the catheter is monitored using an X-ray machine, as well as an ultrasound sensor installed through the esophagus. When the area of ​​the oval window is reached, so-called occluders (or grafts) are inserted through the catheter, which are a “patch” that covers the gaping hole.

The only drawback of the method is that occluders can cause a local inflammatory reaction in the heart tissue. In this regard, in Lately use BioStar absorbable patch. It is passed through a catheter and opens like an “umbrella” in the atrium cavity. A special feature of the patch is its ability to cause tissue regeneration.

After attaching this patch to the area of ​​the hole in the septum, it dissolves within 30 days, and the oval window is replaced by the body’s own tissues. This technique is highly effective and has already become widespread.

All manipulations are performed using the endovascular method (also called transcatheter closure). On right thigh a catheter is installed through which an occluder is delivered to the heart through the vessels using special instruments - a device like an umbrella on both sides. Once the occluder is opened, the hole is securely plugged 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, or use deep anesthesia. For a child who has undergone 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, it is necessary to observe and consult a cardiologist. Discussions about what is “normal” 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.

Many parents worry that the “hole in the heart,” as they call it, will endanger the child’s life. In fact, this 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 have your baby examined by a cardiologist every 6 months with an ultrasound examination.

If the foramen ovale remains open after the child's fifth birthday, it is most likely that it will not heal and will be with the child for the rest of his life. Moreover, such an anomaly has almost no effect on labor activity. It will become an obstacle only to obtaining the profession of a diver, pilot or astronaut, as well as to strong sports loads, for example, weightlifting or wrestling.

At school, the child will be classified in the second health group, and when conscripted, a boy with LLC will be counted in category B (there are restrictions during 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.

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

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

When emboli enter the left atrium, they travel to vessels in the brain and cause brain damage, sometimes fatal. It happens that the presence of a patent foramen ovale helps 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 circle and the vessels of the lungs are unloaded.

Parents whose children have been diagnosed with a patent foramen ovale should follow these recommendations:

• Even in the absence of pronounced symptoms, it is necessary to register the child with a cardiologist. The doctor should monitor the child regularly.
• An open foramen ovale in the heart and sports accompanied by heavy loads are incompatible. Physical exercise should not contain strength exercises and excess voltage abdominal muscles.
• The child should be protected from running, squats, jumping and anything that could provoke a shunt. The daily routine should be properly organized to balance the child’s periods of activity and rest. Must be included in schedule nap.
• Every 2 hours you need to do a little exercise and stretch your leg muscles to prevent the possibility of developing vein diseases in the future. Pay attention to the positions in which the child sits. Get him used to sitting with correct position legs: they should not be tucked and folded crosswise.
• The best way prevention of future stroke - lead an active lifestyle to prevent blood stagnation in the lower extremities and prevent venous diseases.
• Experts recommend hardening and restorative procedures.
• Children with this diagnosis need an annual holiday at a resort and regular walks on the fresh air.
• Make sure your child has enough fluids to drink every day.

Do not let your child notice your concerns about his health - this can lead to panic and increased nervousness. This will not help improve his condition. Always be calm, good-natured and attentive to your child.

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

There are no special methods for preventing an open oval window. To prevent a person from developing a patent oval window, his pregnant mother must be monitored healthy image life:

• quit smoking and alcohol;
• eat rationally and balancedly (limit consumption of fried, spicy, smoked foods, eat more foods high in fiber (vegetables, fruits, herbs).

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

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

Heart pathologies are a very common problem in newborns. The open foramen ovale in the baby's heart is very common diagnosis, with whom the parents of a newborn meet. It is determined using ultrasound of the heart. Of course, this immediately sounds like a death sentence for parents, but is it really that scary? Let's figure it out.

A patent foramen ovale is present in an infant during the period when the child is developing in the womb. At this stage, such an open hole becomes the norm, for proper development fetus When a baby is born, normally this window closes in infants immediately, with the first breath.

The norm is also considered to be the gradual closure of such an opening until the first year of a little person’s life. It often happens that such a window closes before 2.5 years of age, or even before 5 years of age.

This pathology is an unclosed gap in the septum between the right and left atria. After birth, this septum must be completely closed by the heart valve. But as life’s realities show, such a partition still does not close with a valve in half of the planet’s population.

And such a diagnosis is not always a reason for panic and worry. Often people live full life, without even suspecting the presence of such a pathology. You can only find out about it by ultrasound examination.

For the proper functioning of the heart, and the body as a whole, the size of such an open window in the heart matters. The dimensions of such a hole can vary from 2 mm to 10 mm.

1. If such a window opens by 2-3 millimeters, and there are no more cardiac abnormalities, and the person is not worried about anything, then this condition will have practically no effect on the functioning of the body as a whole.
2. If open partition reaches 5-7 mm in size, such pathology is hemodynamically insignificant. Such a deviation can manifest itself only during periods of strong physical stress on the body.
3. But if the window dimensions reach 7-10 mm, then the diagnosis will sound like a “gaping open window”, and in terms of symptoms, this condition is identical to congenital heart disease, which sounds like an atrial septal defect.

Causes of this heart pathology

1. The most common factor is the child's genetic predisposition. This genetic anomaly is transmitted primarily through the first line of family ties.
2. Mother's bad habits. If a pregnant woman drinks alcohol and smokes tobacco, there is also a high probability that the baby will not close the interatrial septum in time.
3. Bad ecology. If a woman’s pregnancy took place in an unfavorable environmental environment, and if the child grows up in the same environment, this pathology may also appear.
4. Poor and unbalanced diet expectant mother, during the period of bearing a child, will also adversely affect the baby’s cardiac system.
5. Permanent stressful situations and depression contribute to the development of such deviations.
6. Severe poisoning of a pregnant woman (including drugs).
7. Having a baby earlier due date. A large percentage of premature babies suffer from this disease.

Forecasts for the future

The presence of a small unclosed oval window (3 mm) in the child’s heart will allow him to lead a full life in the future, if there are no second heart diseases. If there are any, then the presence of an open hole will complicate the course of heart diseases, and the very process of treating such diseases.

In the presence of such a pathology, experts do not recommend serious sports activities for the child. Physical activity should also be moderate.

Constant monitoring of the baby's heart condition is necessary. Such monitoring is carried out through ultrasound of the heart, ECG, and, of course, it is necessary to monitor the general physical condition child.

Signs of this cardiac abnormality in children

Responsible parents should identify the signs of an open foramen ovale in an infant by the following symptoms:

• The baby is not gaining weight well
• Blue discoloration of the circumlabial triangle. This happens when the baby cries, screams, coughs or strains.
• Frequent colds bronchopulmonary in nature

In an older period, the child has a risk of shortness of breath and rapid heartbeat, especially during intense physical exertion.

IN adolescence The disease expresses itself as follows:

• fatigue, fatigue, even without much physical activity;
• headaches of unknown etiology;
• weakness, dizziness, loss of consciousness;
• failures in proper operation heart muscle;
• frequent respiratory diseases, colds

What should you be wary of with this pathology?

The presence of a functioning window in the heart can create a number of undesirable complications, in such cases:

1. The period of active growth of a child. At such a moment, when the heart muscle grows rapidly, and the valve remains the same size, increased blood flow is possible in the connector of the hole, when blood freely penetrates from one atrium to another. This situation increases the load on the atria.
2. Particular vigilance should be exercised in the presence of diseases that increase pressure in the right atrium. Such diseases contribute to additional opening of the valve towards the left atrium.

There are cases when such cardiac pathology is even beneficial for the body. This is availability primary signs pulmonary hypertension. In such a situation, blood from the pulmonary circulation moves through the open window into the left atrium, thus reducing pressure, which has a beneficial effect on the general condition of the body.

Treatment method for this cardiac abnormality

If the open window is not large and there are no heart problems additional diseases in a child, then in this case, the child does not need any medications or manipulations. You can limit yourself to regular observations from a specialist.

If the moderate size of the open hole causes discomfort child's body, it is possible to prescribe anticoagulants and antiplatelet agents.

If it's too big sizes oval window causes decompensated conditions in the child, surgical intervention is necessary.

In any case, for any course of this disease, regular monitoring by a doctor is necessary. Medications It must be given to the child only with a doctor’s prescription. The decision about surgical intervention is made only after the appropriate conclusion of medical specialists. Self-medication is unacceptable for this pathology!

Nutrition

If the oval window is not closed, the child needs good nutrition. The diet must include fruits, vegetables, high content potassium, which strengthens the heart muscle. Legumes are also recommended cereal products, nuts, dairy products and lean varieties of fish and meat.