An unclosed window into the heart. Patent foramen ovale in the heart in adults. Treatment of LLC in the presence of symptoms

A small hole between the left and right atria, which forms during intrauterine development fetus is known as a patent foramen ovale.

What is special about its formation and does it pose a danger to human life?

The essence of LLC

This problem is normal for the fetus, but in adults it is anatomical feature structure of the heart.

The human heart consists of 4 cavities: two atria and two ventricles, which are closely interconnected through special channels. Between the right and left atria is the interatrial septum.

Its role is to regulate blood flow from the left atrium to the right. There are often cases when this septum is formed incorrectly, forming a hole - an open oval window.

The process of blood circulation in children and adults has some differences: during the development of the fetus in the womb, its lungs do not participate in the respiratory process. In this regard, only 12% of the total blood flow passes through them.

This is a necessity for enrichment internal organs fetus (brain, liver, etc.) with oxygen, which is contained in the blood passing through them.

The direction of blood in the fetal body is regulated by special messages that are located in its cardiovascular system, for example, arterial and venous blood flows. Patent foramen ovale is also one of these reports. It pumps oxygenated blood from the right atrium to the left, thereby reducing the flow of blood into the fetal lungs.

From the inside of the cavity of the left ventricle, the opening is covered with a small valve. Before the onset of labor, this valve is already fully formed.

After a newborn baby makes its first cry, its lungs open and oxygen and blood flow into them. This causes the valve to close and increase the pressure level in the left atrium.

After some time, the walls of the valve leaflets gradually grow to the walls of the interatrial septum. This process is finally completed during the first year (in rare cases - by 5 years).

It is possible that the valve leaflets are too small, which cannot ensure complete closure of the opening between the atria. It is in this case we're talking about about the development of OO windows.

According to statistics, an open oval window in adults (in 30% of all cases) entails the development various diseases cordially- vascular system or lung pathology.

The main reason for this situation is the increased intracardiac blood pressure. Since the development of this problem begins in the prenatal period of fetal development, in adults PFO is considered a heart defect.

Causes

As a result of the fact that the open oval window remains open or slightly open, when severe cough, crying or as a result of tension abdominal cavity blood is ejected from the right atrium to the left. This is a clear manifestation of the action of an OO window.

To date, experts have not been able to fully understand the exact reasons that lead to the occurrence of this pathology. Among known factors include:

• hereditary factor;
• prematurity;
• congenital defect of the mitral or tricuspid heart valves;
• connective tissue dysplasia;
• negative environmental impact;
• smoking;
• drinking alcoholic beverages during pregnancy.

Experts also include in the risk group people whose bodies are exposed to heavy physical stress, including athletes. You should also not exclude from this group those whose profession involves diving to great depths.

Patients diagnosed with thrombophlebitis of the legs or MT, accompanied by moments of pulmonary embolism, usually suffer from high blood pressure the right side of the heart are also at risk for the development of a functioning LLC.

If a person is at risk or a pregnant woman has been exposed to the above factors, you should immediately contact a specialist to undergo comprehensive examination. This can reveal the presence of pathology and prevent heart disease.

Symptoms, dangers and treatment

As a rule, an open oval window is small in size and does not cause any discomfort in patients.

If PFO was not diagnosed and eliminated in childhood, this anomaly can provoke manifestation of such signs:

• fast fatiguability;
• weakness;
• exposure to frequent respiratory infections: cough, sore throat, bronchitis, etc.;
• shortness of breath, which tends to manifest itself not only with large physical activity, but also with moderate ones;
• dizziness;
• severe headaches;
• migraine;
• frequent fainting conditions.

Unfortunately, it is not always possible to identify an OO window with normal medical examination. Typically, pathology is discovered only after the patient begins to exhibit complications of this anomaly.

WITH Some of the most common complications include:

• transient type of cerebral circulatory disorder - characterized by short-term disturbances in the functioning of the human brain. The main reason for this is the failure of the blood supply process in the GM. In this case, a person experiences loss of speech, memory, numbness of the upper or lower extremities, and disruption of the activity of certain parts of the body. Maximum duration the manifestation of these symptoms does not exceed a day;
• stroke is quite severe and dangerous complication LLC, which consists of the death of certain areas of muscle tissue. In this case, the patient exhibits symptoms similar to those seen in a transient disruption of the blood supply to the brain. A distinctive feature of this condition is that the duration of manifestation of these symptoms is much more than 24 hours;
• kidney infarction - manifests itself in the form of death of part of the kidney, which is accompanied by severe pain in the lumbar region, bloody discharge in urine, a small amount secreted urine, increased body temperature.

It is also worth noting that a patent foramen ovale is extremely dangerous for people who dive. This is due to the fact that they are at increased risk of developing decompression sickness. In order to obtain permission to dive below 10 meters, such people need to close the LLC.

An open oval window is dangerous due to the possible development of complicating processes. To reduce the risk, you should immediately contact a specialist for a comprehensive examination.

The choice of treatment method for this pathology depends on the size foramen ovale, the presence of complications, as well as concomitant diseases.

Usage drug therapy will not cause the window to close completely. For this purpose, the method of surgical catheterization or surgery is used. In most cases, the pathology does not require treatment. Patients with this anomaly live long and fulfilling lives, work and give birth to children.

In order to avoid the development of complications, children diagnosed with a patent foramen ovale should be under the supervision of specialists. As for adult patients, they should also undergo periodic medical examinations.

Nowadays, many parents often hear from the doctor that their baby has an open foramen ovale in the heart. In this article we will try to find out what it is - a serious diagnosis or congenital feature structure of the heart.

The heart of a newborn baby is very different from the heart of an adult. The heart consists of four chambers (atria and ventricles), and in adults there is a septum between the atria that does not allow the arterial and venous blood in the left and right halves of the heart, respectively. In newborn children, the interatrial septum is not always a complete formation due to the following features blood circulation of the fetus: when the baby is still developing in the womb of a woman, the lungs do not take part in spontaneous breathing, therefore less blood flows to them (only 12% of the total blood flow of the fetus). This is necessary so that more oxygen-enriched blood is received by the actively functioning organs of the fetus - the brain, liver, etc. For the correct distribution of blood volumes in the baby’s body, there are vascular communications (messages) in his cardiovascular system. One of these structures, along with the arterial and venous ducts, is the oval window - this is an opening between the atria that discharges blood from the right to the left atrium to reduce blood flow to the lungs.

On the side of the left ventricle, the window is covered by a small valve, which is fully mature for childbirth. At the moment of the newborn’s first cry, when his lungs open, the blood flow to them increases, the pressure in the left atrium increases, and the valve closes the window, and subsequently firmly fuses with the wall of the interatrial septum (in most cases during the first year of the child’s life, less often - up to five years). Sometimes this valve is too small in size to close the hole, and then they say that the newborn has a patent foramen ovale in the heart.

An open foramen ovale is an opening between the atria in the human heart, through which blood can flow from one atrium to another (usually from the left to the right, since physiologically the pressure in the cavity of the left atrium is higher). A patent foramen ovale should not be confused with an atrial septal defect, since the defect is a more serious diagnosis related to congenital heart defects, while a patent foramen ovale is classified as one of the minor anomalies of cardiac development, and is, rather, individual feature structure of the child's heart.

Patent foramen ovale

Causes of patent oval window in the heart

In first place in the structure of causes of morbidity is genetic predisposition, especially on the maternal side. Also, as reasons, we can note factors that have a negative impact on the fetus during gestation - unfavorable environmental conditions, insufficient nutrition of the pregnant woman, stress, use of toxic substances (alcohol, drugs, nicotine, medications prohibited for use by pregnant women).

Symptoms of an open oval window

Usually clinical manifestations isolated oval window in children (without the presence birth defects hearts) are quite scarce. This structural anomaly in a newborn child can be suspected on the basis of the following complaints: rapid heartbeat, shortness of breath and cyanosis (gray or blue coloring) of the nasolabial triangle during crying and feeding. The child may have poor appetite and poor weight gain. Older children may have decreased tolerance (tolerance) to physical activity.

During the period of intensive growth, as well as hormonal changes in the body ( adolescence, pregnancy), the load on the cardiovascular system as a whole increases, which can cause fatigue, weakness, and a feeling of interruptions in the functioning of the heart, especially during physical activity or sports.

In situations where the oval window does not heal even after the age of five, most likely it will accompany the person throughout his life, which, however, does not in any way affect his everyday and work activities. But at an older age (after forty to fifty years), when a person may develop diseases such as arterial hypertension And ischemic disease heart, the oval window can complicate the course of the recovery period after myocardial infarction and the course of chronic heart failure.

Diagnosis of the disease

Diagnosis is based on auscultation (listening) chest when examining the child (systolic murmurs are heard), as well as on the basis instrumental methods research.

The main method for detecting a foramen ovale is imaging using echocardiography (ultrasound of the heart). Cardiac ultrasound should be performed on all children aged 1 month according to new therapeutic and diagnostic standards in pediatrics.

If the oval window is accompanied by congenital heart defects, then, if necessary, the doctor prescribes transesophageal echocardiography, an angiographic study (introduction of an X-ray contrast agent into the heart cavity through the vessels), carried out in a specialized cardiac surgery hospital.

Treatment of open oval window

With absence clinical symptoms and hemodynamic disorders ( pronounced changes in the work of the heart), which is most often found in the practice of a pediatrician, nor drug therapy, nor hospitalization in a hospital are not indicated. General strengthening procedures are prescribed - hardening, walks on fresh air, maintaining a balanced work and rest regime, proper nutrition, physiotherapy.

If minor complaints from the cardiovascular system occur, it may be justified to prescribe vitamins and drugs that provide additional nutrition to the heart muscle - magnesium B6, panangin, L-carnitine analogs (Elcar), coenzyme Q (ubiquinone).

In cases of combination with heart defects, the tactics of observation and treatment are determined by a cardiologist and cardiac surgeon with the choice of the optimal method of surgical correction of the defects. IN last years London scientists have developed an operation in which a probe with a patch is inserted into the cavity of the right atrium through the femoral vein, which is applied to the window and dissolves within 30 days. This patch creates a kind of “patch” and additionally stimulates the formation of its own connective tissue in the interatrial septum, which leads to closure of the oval window. Surgical treatment is not used in uncomplicated cases.

Complications of patent oval window in the heart

Extremely rare, almost isolated cases of complications include “paradoxical” embolism – a dangerous, life-threatening condition. Emboli are tiny particles, carrying gas bubbles, blood clots or pieces of fatty tissue. These substances should not normally be in the bloodstream, but they enter the bloodstream under different conditions. pathological conditions, for example, gas bubbles during air embolism, sometimes accompanying complex chest injuries with damage lung tissue; blood clots – with thrombophlebitis (vein diseases with the formation of wall blood clots); adipose tissue– with open bone fractures. The danger of these emboli is that when the foramen ovale is open, they can get from the right to the left atrium, then into the left ventricle, then through the vessels to reach the brain, where, clogging the lumen of the vessel, they will cause the development of a stroke or cerebral infarction. This complication can be fatal. It manifests itself as suddenly developing brain symptoms either immediately after injury, or during a period of prolonged immobilization, when the patient, after serious operations, injuries, serious illnesses forced to remain in bed for a long time. Prevention of the development of thromboembolic complications in general is adequate therapy aimed at preventing increased blood clotting in acute diseases cardiovascular system, during injuries, during surgical interventions, etc.

As already mentioned, this complication is quite rare, but nevertheless, a patient with a patent foramen ovale should always warn his doctor about the presence of this structural feature of the heart.

Prognosis for open oval window

Forecast for life, social and labor activity generally favorable, but exercises are contraindicated for patients with a patent foramen ovale extreme species sports, as well as professions associated with increased load on the circulatory and respiratory systems - pilots, astronauts, divers.

To summarize everything written above, it should be noted that in modern medicine It is customary for doctors to attribute a patent foramen ovale more to the structural features of the heart than to serious developmental defects, since in most cases the functional load on the heart remains within normal limits. But still, due to the localization of this pathology in the heart, it is vital important body, its importance should not be underestimated. In any case, the patient’s management tactics are determined individually by the cardiologist during an in-person examination.

General practitioner Sazykina O.Yu.

– incomplete closure of the foramen ovale in the interatrial septum, which normally functions during the embryonic period and closes in the first year of the child’s life. An open foramen ovale can be manifested by cyanosis of the nasolabial triangle, slow physical development, shortness of breath and tachycardia, sudden fainting, headache, frequent acute respiratory viral infections and bronchopulmonary diseases. Diagnosis of an open foramen ovale includes an ECG (at rest and after exercise), conventional and Doppler echocardiography, radiography, and probing of the cardiac cavities. With an open foramen ovale, anticoagulant therapy can be used, and, if necessary, surgical treatment (endovascular occlusion of the defect).

General information

Patent foramen ovale is a congenital communication between the right and left atria, representing a residual element of the foramen ovale of the fetal heart. The interatrial foramen with a valve is formed in utero and is a necessary condition for the functioning of the cardiovascular system during this period of development. Thanks to the open foramen ovale, part of the placental, oxygenated blood flows from the right atrium to the left, bypassing the undeveloped, non-functioning lungs, and ensures normal blood supply to the neck and head of the fetus, the development of the brain and spinal cord.

In healthy full-term children under normal developmental conditions, the patent foramen ovale usually closes and ceases to function within the first 12 months after birth. But its closure occurs individually for each person: on average, by the age of 1 year, the oval window remains open in 40-50% of children. The presence of an open foramen ovale after 1-2 years of a child’s life is classified as minor anomalies of cardiac development (MARS syndrome). In mature patients, a patent foramen ovale is detected in approximately 25-30% of cases. The fairly high prevalence of patent foramen ovale determines the relevance of this problem in modern cardiology.

Causes of a patent oval window

All children are born with a patent foramen ovale. After the first independent breath, the newborn’s pulmonary circulation turns on and begins to fully function, and there is no need for an open foramen ovale. An increase in blood pressure in the left atrium compared to the right leads to the closure of the oval window valve. In most cases, the valve closes tightly and closes completely connective tissue- the open oval window disappears. Sometimes the hole closes partially or does not close at all and under certain conditions (with hacking cough, crying, screaming, tension in the anterior abdominal wall) blood is discharged from the right atrial chamber to the left (functioning oval window).

The reasons for incomplete closure of the oval window are not always clear. It is believed that a patent foramen ovale can be caused by hereditary predisposition, prematurity, congenital heart defects, connective tissue dysplasia, exposure to adverse environmental factors, smoking and alcohol consumption by women during pregnancy. Due to genetic characteristics, the diameter of the valve may be smaller than the diameter of the oval opening, which will prevent its complete closure.

A patent foramen ovale may be accompanied by congenital defects of the mitral or tricuspid valves, or a patent ductus arteriosus.

Risk factors for the opening of the oval window valve may include significant physical activity in athletes involved in weightlifting, wrestling, and athletic gymnastics. The problem of an open oval window is especially relevant for divers and divers who dive to significant depths and have 5 times more high risk development of decompression sickness. In patients with thrombophlebitis of the lower extremities or pelvis with a history of episodes of pulmonary embolism, contraction of the pulmonary vasculature can cause increased pressure in the right side of the heart and the appearance of a functioning patent foramen ovale.

Features of hemodynamics with an open oval window

The open foramen ovale is located at the bottom of the oval fossa on the inner left wall of the right atrium, often has a small size (about the size of a pinhead) and a slit-like shape. The size of a patent oval window averages 4.5 mm, but can reach 19 mm. An open foramen ovale, in contrast to an atrial septal defect, has a valve structure that ensures the variability of interatrial communication and the ability to discharge blood in only one direction (from the pulmonary circulation to the large one).

The clinical significance of a patent foramen ovale is controversial. A patent foramen ovale may not cause hemodynamic disturbances and may not have negative impact on the patient's health through small size and the presence of a valve that prevents blood from shunting from left to right. Most people with a patent foramen ovale are unaware of this anomaly and lead normal lives.

The presence of a patent foramen ovale in patients with primary pulmonary hypertension is considered prognostically favorable in terms of life expectancy. However, excess pressure in the right atrium compared to the left with an open foramen ovale leads to the periodic occurrence of a right-to-left shunt, which allows a certain volume of blood to pass through and leads to hypoxemia, transient cerebrovascular accidents (TIA), and the development of life-threatening complications: paradoxical embolism, ischemic stroke , myocardial infarction, kidney infarction.

Symptoms of an open oval window

The open oval window does not have specific external manifestations; in most cases it occurs latently, sometimes it can be accompanied by scant symptoms. Indirect signs an open oval window may be: severe pallor or cyanosis of the skin in the area of ​​the lips and nasolabial triangle during physical stress (crying, screaming, coughing, straining, bathing a child); tendency to frequent colds and inflammatory bronchopulmonary diseases; slower physical development of the child (poor appetite, insufficient weight gain), low endurance during physical activity, combined with symptoms of respiratory failure (shortness of breath and tachycardia); sudden fainting and symptoms cerebral circulation(especially in young patients, with varicose veins, thrombophlebitis of the lower extremities and pelvis).

Patients with a patent foramen ovale may experience frequent headaches, migraines, postural hypoxemia syndrome - the development of shortness of breath and decreased saturation arterial blood oxygen in a standing position with improvement when moving to horizontal position. Complications of a patent oval window occur rarely. For paradoxical embolism cerebral vessels, aggravating this anomaly, is characterized by a sudden development of neurological symptoms and a fairly young age of the patient.

Diagnosis of an open oval window

Studying the medical history and physical examination of the patient often does not immediately allow one to determine the presence of an open foramen ovale, but can only assume the possibility of this anomaly of the interatrial septum (cyanosis of the skin, fainting, frequent acute respiratory viral infections, developmental delay in the child). Auscultation helps identify the presence of a heart murmur as a result of an abnormal shunt of blood from a higher-pressure chamber to a lower-pressure chamber.

To establish an accurate diagnosis of an open oval window, instrumental studies and visualization methods: ECG (at rest and after exercise), conventional and Doppler echocardiography, chest radiography, probing of the cardiac cavities.

When the foramen ovale is open, changes appear on the electrocardiogram indicating an increase in the load on the right parts of the heart, especially on right atrium. In older people with a patent oval window, radiological signs enlargement of the right chambers of the heart and increased blood volume in the vascular bed of the lungs.

In newborns and young children, transthoracic two-dimensional echocardiography is used, which makes it possible to visually determine the presence of an open oval window and its diameter, obtain a graphic image of the movements of the valve leaflets over time, and exclude an atrial septal defect. Doppler echocardiography in graphical and color mode helps to clarify the presence and size of an open oval window, identify turbulent blood flow in the area of ​​the oval foramen, its speed and the approximate volume of the shunt.

In older children, adolescents and adults, a more informative transesophageal echocardiography, supplemented by a test with bubble contrast and a test with straining (Valsalva maneuver), is used to diagnose a patent foramen ovale. Bubble contrast improves the visualization of the open oval window, allows you to determine its exact dimensions, and assess the pathological blood shunt.

The most informative, but more aggressive method for diagnosing an open foramen ovale is cardiac catheterization, which is performed immediately before surgical treatment in a specialized cardiac surgery hospital.

Testing for the presence of a patent foramen ovale should be performed in patients with varicose veins, thrombophlebitis, cerebrovascular accident, chronic diseases lungs at risk of developing paradoxical embolism.

Treatment of open oval window

With an asymptomatic course, a patent oval window can be considered a normal variant. Patients with a patent foramen ovale and a history of a transient ischemic attack or stroke are prescribed systemic therapy with anticoagulants and antiplatelet agents (warfarin, acetylsalicylic acid) to prevent thromboembolic complications. The method for monitoring anticoagulant therapy is the international normalized ratio (INR), which should be in the range of 2-3 when the foramen ovale is open.

The need to eliminate a patent foramen ovale is determined by the volume of shunted blood and its effect on the functioning of the cardiovascular system. If there is a small discharge of blood, there are no concomitant pathologies and complications, surgery is not required.

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

Prognosis of open oval window

For patients with a patent foramen ovale, regular monitoring by a cardiologist and echocardiography are recommended. Endovascular occlusion of the patent foramen ovale allows patients to return to their normal rhythm of life without restrictions. In the first 6 months after surgical treatment open foramen ovale, antibiotics are recommended to prevent the development of bacterial endocarditis. The greatest effect from endovascular closure of the patent foramen ovale is observed in patients with platypnea who had a pronounced right-to-left shunt.

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

Circulation

From the hollow bottom and superior vein the flow enters the right atrium. Next, the blood passes through the tricuspid valve, consisting of 3 petals. It then enters the right ventricle. Through pulmonary valve and the trunk flow enters pulmonary arteries, and then into the lungs. Gas exchange occurs there, after which the blood returns to the left atrium. Then through the bicuspid mitral valve, consisting of two petals, it penetrates into the atrium. Further, passing through aortic valve, the flow enters the aorta.

Anatomy

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

General information about pathologies

One of the main tasks of medicine today is the treatment of heart disease. According to statistics, mortality from CVD pathologies is growing rapidly throughout the world every year. A study of the causes of diseases of the cardiovascular system has shown that some of them are caused by infection, others are hereditary or congenital. The latter are diagnosed quite often. As a rule, such pathologies do not manifest themselves and are revealed exclusively during preventive examinations. However there are several congenital pathologies, clinical picture which is obvious. So, for example, if the lumen in the aorta is too narrow, the blood pressure in the upper and decreases in the lower region of the body. With such a congenital pathology, a complication may be a cerebral hemorrhage. Patients are often diagnosed with any holes in the septum. Also, the open foramen ovale in the heart may not heal, and the botal duct (the vessel connecting the aorta and artery in the prenatal period) may remain.

Against the background of these defects, a mixture of arterial and venous blood occurs, as a result of which insufficient oxygen is distributed throughout the body. As a result, cyanosis of the limbs and face begins, shortness of breath, the tips of the fingers specifically expand and become like Drumsticks. In addition, the level of red blood cells increases. Saturation of the blood with oxygen is also hampered by aplasia or hypoplasia of the pulmonary artery.

Patent foramen ovale in the heart

It functions in humans during the embryonic period. During the first year of life, a child's open foramen ovale usually heals. However, in some cases this does not happen. The location of the hole is the interatrial septum. An open foramen ovale with non-closure can manifest itself as delayed physical development, cyanosis in the area of ​​the nasolabial triangle, tachycardia and shortness of breath. Sudden fainting, headaches, bronchopulmonary pathologies and frequent acute respiratory viral infections are also observed.

Patent foramen ovale in newborns - necessary condition for the functioning of the cardiovascular system in the prenatal period. Thanks to the presence of this opening, a certain volume of oxygenated placental blood enters the left atrium from the right. In this case, the flow bypasses the non-functioning, undeveloped lungs, ensuring normal nutrition of the fetal head and neck, development of the spinal cord and brain.

Relevance of the problem

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

Fusion process

Newborns always have an open foramen ovale. After the first spontaneous inhalation, the pulmonary circulation of blood flow is turned on (it begins to fully function). Over time, the child's open oval window should heal. This happens due to more high pressure in the left atrium compared to the right. Because of the difference, the valve closes. Then it is completely overgrown with connective tissue. This is how the child’s open oval window disappears.

Causes of the problem

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

The reasons that influence the fact that the open oval window in the heart does not heal are not always clear. There is a very widespread opinion that this defect is caused by hereditary predisposition, congenital defects, and prematurity. Causes also include connective tissue dysplasia, adverse effect external factors, alcohol consumption and maternal smoking during pregnancy. There are also genetic characteristics that cause the valve diameter to be smaller than the opening. This will create an obstacle to its complete closure. This defect may accompany congenital malformations of the tricuspid or mitral valve.

Risk factors

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

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

Features of hemodynamics

The floor of the fossa ovale on the inner left side of the wall of the right chamber is where the patent foramen ovale is located. Dimensions (the average is 4.5 mm) may vary. In some cases they reach 19 mm. As a rule, the hole has a slit-like shape. An open window, unlike a defect in the interatrial septum, differs in its valve structure. It ensures inconsistency of communication between the chambers, the possibility of blood ejection exclusively in one direction (from a small to a large circle).

Experts have mixed opinions clinical significance holes. An open window may not provoke hemodynamic disturbances and not negatively affect the condition of patients due to the presence of a valve that prevents the flow of blood from left to right, and its small size. Most people with this defect are unaware of its presence.

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

Symptoms

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

Characteristic signs

Indirect manifestations of the functioning of an open window include severe pallor or cyanosis skin in the area of ​​the nasolabial triangle or lips in the background physical stress, predisposition to the occurrence of frequent colds and inflammatory bronchopulmonary pathologies, delayed physical development. The latter means insufficient weight gain, poor appetite, etc. Also, the presence of an open oval window is indicated by poor endurance during physical activity in combination with symptoms of insufficiency respiratory system(tachycardia and shortness of breath), sudden fainting, signs of cerebrovascular accident. The latter is especially important for young patients, people with varicose veins, thrombophlebitis in the pelvis and lower extremities.

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

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

Diagnostics

The examination is carried out using several methods. Diagnostics includes ECG, ultrasound of the heart. An open oval window is examined using cavity probing and radiography. If there is a defect in the electrocardiogram, changes are observed that indicate an increase in the load on right area the body in question.

In older patients, when the window is open, radiographic signs of increased blood volume in the pulmonary vascular bed and enlargement in the right heart chambers may be detected.

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

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

Therapeutic measures

In the absence of adverse symptoms, an open window can be considered normal. For patients with an active hole in the presence of cases of transient ischemic attack or a history of stroke, systemic therapy with disaggregants and anticoagulants (such as Aspirin, Warfarin, and others) is recommended to prevent the occurrence of thromboembolic complications. As a method of monitoring treatment, the INR (international ratio) is used, which, when the window is open, should be within 2-3 units. The need to eliminate the hole is determined in accordance with the volume of ejected blood and its effect on the activity of the cardiovascular system.

With a small shunt, when the open oval window is 2 mm or around this indicator, surgery, as a rule, is not prescribed. In case of severe pathological backflow of blood, low-traumatic x-ray endovascular occlusion is recommended. The operation is performed under echocardioscopic and x-ray control. During the intervention, a special occluder is used, which, when opened, completely blocks the window.

Forecast

Patients diagnosed with a patent foramen ovale in the heart are recommended to undergo regular examination by a cardiologist and undergo echocardiography. After endovascular occlusion has been performed, patients can return to ordinary life without any restrictions. During the first six months after surgical intervention Patients are recommended to take antibiotics. Similar drugs used to prevent the occurrence of bacterial endocarditis.

The most effective closure of the oval window by the endovascular method is in patients with platypnea, with a pronounced release of blood flow from right to left. Preventive measures, preventing many congenital pathologies are the following: following a diet and daily routine during pregnancy, visiting a gynecologist, giving up bad habits.

Finally

Experts recommend regular examinations for patients at risk. These, in particular, include persons with varicose veins, cerebrovascular accidents, thrombophlebitis, chronic pulmonary pathologies, and a predisposition to the development of paradoxical embolism. During pregnancy, a woman should be under close medical supervision and monitor her diet and exercise.

The oval window in the heart is a hole developed in utero, covered with a special fold-valve, which is located on the septum between the atria. This window communicates between the right and left atria of the fetus during the embryonic period. Thanks to it, part of the oxygenated placental blood can flow from the right atrium to the left, bypassing the non-functioning lungs of the unborn baby. This ensures normal blood supply to the head, neck, brain and spinal cord.

During the first breath, the child’s lungs and pulmonary circulation begin to function, and the need for communication between the right and left atria loses its relevance. When the baby inhales and first cries, the pressure created in the left atrium becomes higher than in the right, and, in most cases, the valve slams and closes the oval window. Subsequently, it is overgrown with muscle and connective tissue and completely disappears. But it happens that the oval window remains open. What threatens this condition, how to correct it in a newborn and whether it needs to be done - this is what this article is about.

The oval window in 40-50% of full-term healthy newborns is anatomically closed by a valve already in the first 2-12 months of life, and its functional closure occurs at 2-5 hours of life. Sometimes it remains partially open or, under certain conditions (valve defect, strong crying, screaming, tension in the anterior abdominal wall, etc.) does not close. The presence of a patent foramen ovale after 1-2 years is considered a minor anomaly of cardiac development (MARS syndrome). In some cases, the oval window can close at any other time and completely spontaneously. Among adults, it is observed in 15-20% of cases. The prevalence of this anomaly has become actual problem for cardiology and requires monitoring.

The exact reasons that the oval window does not close on time are unknown to modern medicine, but, according to some studies, the presence of this anomaly can be provoked by a number of predisposing factors:

• heredity;
• infectious diseases of the mother during pregnancy;
• smoking and alcohol abuse on the part of the mother or father;
• parental drug addiction;
• phenylketonuria or diabetes at the mother's;
• taking certain medications during pregnancy (some antibiotics, lithium preparations, phenobarbital, insulin, etc.);
• prematurity of the child;
• connective tissue dysplasia, etc.

Symptoms

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 oval window measuring 4.5-19 mm or incomplete closure of the valve, the child may experience transient cerebrovascular accidents, signs of hypoxemia and the development of such severe complications, such as ischemic stroke, renal infarction, paradoxical embolism, etc.

More often, a patent foramen ovale 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 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.”

Possible complications

In extremely rare cases, a patent foramen ovale may be complicated by the development of paradoxical embolism. Emboli can become small gas bubbles, blood clots, or small fragments of fatty tissue. When the foramen ovale is open, they can enter the left atrium, then into the left ventricle. With the blood flow, the embolus can enter the vessels of the brain and cause the development of a cerebral infarction or stroke: conditions that can be fatal. This complication appears suddenly and can be caused by trauma or prolonged bed rest during periods of serious illness.

Diagnostics

To confirm the diagnosis of “patent foramen ovale,” the child must be examined by a cardiologist who can evaluate the results of an ultrasound of the heart and. In newborns and children younger age A transthoracic Doppler echo-CG is performed, which allows one to obtain a two-dimensional image of the interatrial wall and the movement of the valves in time, to assess the size of the oval window or to exclude the presence of a defect in the septum.

After confirmation of this diagnosis and in case of exclusion of other heart pathologies, it is recommended that the child dispensary observation With mandatory repeat ultrasound of the heart once a year to assess the dynamics of the heart abnormality.

Treatment

In the absence of significant hemodynamic disturbances and symptoms, a patent foramen ovale in a newborn can be considered a normal variant and requires only constant monitoring by a cardiologist. Parents are advised to walk with their child in the fresh air more often, perform physical therapy and hardening procedures, and follow the rules balanced nutrition and daily routine.

Drug therapy can only be indicated for children with signs of 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, drugs for additional nutrition of the myocardium (Panangin, Magne B6, Elcar, Ubiquinone) and 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. At minor violation blood circulation and the absence of concomitant congenital heart defects surgery not required.

In case of severe hemodynamic impairment, a low-traumatic operation for endovascular transcatheter closure of the hole with a special occluder may be recommended. This surgical intervention is performed under radiographic and endoscopic equipment. A special probe with a “patch”-plaster is inserted into the right atrium through the femoral artery. This “patch” blocks the lumen between the right and left atrium and stimulates its overgrowth with its own connective tissue. After performing such an operation, the patient is recommended to take antibiotics for six months to prevent the occurrence. After this, the patient can return to his normal lifestyle without any restrictions.

Forecasts

In most cases, a patent foramen ovale in newborns and children under two years of age does not cause serious complications and does not bother the child. In most children, it completely heals by the age of five and does not in any way affect further physical and social activities. For patients with a patent foramen ovale without serious hemodynamic disturbances, cardiologists recommend excluding extreme sports and choosing professions that are associated with excessive load for respiratory and cardiovascular system(divers, pilots, astronauts).