Congenital heart defect: open foramen ovale. Open oval window (hole) in the heart: causes, closure, prognosis Heart with a hole

The patent foramen ovale in the heart is a small hole located in the septum directly between the right and left atria. Normally, they should not communicate with each other to prevent mixing of arterial and venous blood, as well as pressure changes. This condition is a pathological phenomenon in adults and children of a certain age and is very common. Sometimes the disease does not cause serious physical discomfort, but in some cases it can lead to various disorders in the functioning of the cardiovascular system and requires treatment.

The presence of an oval-shaped depression is normal, because during pregnancy, while the fetus’s lungs are not functioning and its body requires additional oxygen, blood is transferred to the left atrium through this hole. The absence of such a duct during intrauterine development can lead to various anomalies and even the death of the child before birth or immediately after it.

When the baby takes his first breath, the respiratory system starts working and his lungs instantly expand. The increased pressure in the left side of the heart stops the flow of blood through the foramen ovale.

In a newborn baby, the foramen ovale in the heart should close within a few days or weeks. But very often, during the next scheduled medical examination, it is discovered that this did not happen, and the doctor informs the parents about pathological abnormalities in the development of the infant’s cardiovascular system. An unclosed oval window in most cases requires some treatment, but the famous pediatrician E.O. Komarovsky advises parents not to panic and not resort to radical measures. In his works, he emphasizes the fact that in almost half of all newborns there is no sudden closure of the hole in the cardiac septum and it can remain open for a long time, up to the age of five.

Despite the fact that an unclosed passage in the septum between the two atria can be considered normal for some time, there are other factors in the occurrence of a physical defect. They can cause the development of various pathological changes in the functioning of the heart muscle. These factors include:

smoking and drinking alcohol during pregnancy;
various malformations of intrauterine development (including infection);
taking medications inconsistently with a doctor;
hereditary factor.

If the child was born prematurely, this also increases the risk that the hole in the heart will not close, and blood will be transferred through it with a weak pulsation. With various anomalies in the structure and development of the heart muscle, a sharp opening of the previously connected oval window may occur due to temporary stretching of the chambers of the left and right atria.

Symptoms

In some cases, the hole does not heal even after several years of life. If a teenager has an unclosed window, then this defect will definitely remain with him forever. Why is this dangerous? In fact, according to official statistics, this phenomenon accompanies at least 25% of the entire adult working population throughout their lives. At the same time, restrictions are imposed only on extreme sports and activities associated with constant physical activity. Caution is necessary because the presence of an open foramen ovale in the heart in an adult can lead to sudden changes in blood pressure.

Much less common are cases with a pronounced clinical picture of the disease, when the following pathological conditions make themselves felt:

diseases of the respiratory system;
cerebral circulatory disorders and tendency to thrombosis;
phlebeurysm;
severe headaches of a chronic nature;

exceeding the normal level of blood volume in the lungs;
exercise intolerance;
arrhythmia and shortness of breath;
numbness of the limbs;
impaired mobility of different parts of the body;
pathological changes in the right atrium (usually clearly visible during ultrasound);
systematic fainting of unknown etiology.

In most cases, the disease is hidden and difficult to diagnose, so it is detected through random medical examinations and checks. The lack of specific signs also complicates the search for the main cause of ailments in adults, because the above symptoms occur in various pathologies.

Possible complications

An open window in the heart rarely poses a serious threat to human health and has virtually no effect on life expectancy, but worsens its quality. But this pathology, in combination with other chronic respiratory diseases, varicose veins and thrombophlebitis, can lead to serious complications, which include:

myocardial infarction;
kidney infarction;
stroke.

In addition, a temporary disruption of the blood supply to the brain may occur, which can lead to memory loss, central nervous system depression, body immobility, numbness of the limbs and speech defects. After some time, these symptoms may disappear without a trace.

Treatment of the disease

If a medical examination reveals an open depression in the heart, but it does not bring any physical discomfort to the person, then no special treatment is performed. For minor complications, various drugs are prescribed to prevent the formation of deep vein thrombosis.

In some cases, the defect can be corrected through surgery.

Doctors often use special absorbable patches, which are temporary patches for the oval window.

During the period of their use, connective tissue grows, which subsequently closes the duct between the atria.

Forecast

This disease generally has a good prognosis, but in order to avoid various complications, periodic ultrasound examinations (especially for newborn children) and visits to a cardiologist are required. You should also avoid physical fatigue and increased stress.

The same rules apply for teenagers. Parents should not send their children to boxing or martial arts classes, and it is better to avoid school competitions if possible, providing a certificate in advance about the presence of a birth defect.

If you exclude all kinds of risks and treat concomitant diseases in a timely manner, you can live almost your entire life without remembering this problem. Pathology is not an obstacle to pregnancy and natural childbirth, but a woman must notify her obstetrician-gynecologist. In old age, the disease sometimes causes heart failure, so from time to time it is necessary to undergo routine examinations and carry out prevention with the help of medications or traditional medicine.

If a child over 2 years of age has a hole in the interatrial septum, then this is a likely sign of a patent foramen ovale (PFO). Normally, it functions in the fetus and then heals. Children with this pathology are stunted, they often experience cyanosis, shortness of breath, headache and sudden loss of consciousness. Treatment depends on the size of the defect. Medicines and surgical methods are used.

Read in this article

What is a patent oval window?

LLC during the period of fetal formation is necessary, since through it the placental blood enters from the right to the left atrium, and not into the lungs. This ensures blood supply to the brain and spinal cord. The hole is located in the center of the septum and is equipped with a valve that inhibits the reverse flow of blood.

Fetal circulation

After birth, all children have an LLC. But after the child begins to breathe on his own, the need for his existence disappears. Higher pressure in the left atrium presses the valve, and it gradually grows to the septum.

If there is an unclosed part, or the window is not completely covered, then, with a strong cough or cry, the blood is discharged from right to left. The window may be open in half of children after one year and in a quarter of adults.

Causes of an open oval window

There is a hereditary predisposition to the formation of an LLC. If there is a violation of the structure of the chromosome or defects in genes, the valve is smaller in size than the size holes. This pathology also occurs due to unfavorable factors:

premature birth;
disruption of the structure of connective tissue;
congenital anomalies of heart development: valve defects and;
bad habits of the mother: smoking, drug addiction, alcoholism.

The window can open during scuba diving when diving to great depths (divers, divers), professional weightlifters, wrestlers, and when engaging in high-intensity strength sports. With vein thrombosis with blockage of the pulmonary artery, the pressure in the right side of the heart increases, this provokes the opening of the hole.

Blood circulation with an open oval window

The LLC is about 5 mm in size and has the appearance of a slit. Sometimes you can find a hole with a diameter of about 2 cm. Unlike a congenital septal defect, the window is covered by a valve. Therefore, a small discharge of blood may not manifest itself in any way, and most people are unaware of its existence.

If the pressure in the pulmonary artery system is high, then LLC compensates for it and is considered a favorable sign for life expectancy. With a significant flow of venous blood from the right atrium in patients, the oxygen content in the tissues decreases, and circulatory disorders of the brain and myocardium occur.

Signs and symptoms of a patent oval window

Manifestations of PFO are not specific, in most cases they do not have clinical symptoms, so the diagnosis is made late.

Symptoms in children

Indirect evidence of pathology may be a sharp pallor or bluish color of the skin during a baby's crying, screaming or bathing. Due to insufficient
oxygen supplies to tissues occur:

frequent bronchitis, colds;
weak appetite;
lag in weight gain;
physical development is slow;
dyspnea;
episodes of loss of consciousness.

Signs of LLC in adults

Patients are worried about headaches, migraine attacks, and dizziness. At the same time, in a standing position, shortness of breath and palpitations intensify, and with the transition to a horizontal position, they weaken. Young people show signs of impaired blood supply to the brain, including strokes.

Why did the open foramen ovale not close in the child?

If, as the heart grows, the valve that covers the oval window does not increase, then the hole does not close tightly. Ultimately, blood flows from one atrium to another, creating increased stress.

Pathology can be caused by conditions that contribute to increased pressure in the right atrium: lung diseases, combined heart defects, developmental disorders of the venous system.

The danger posed by an open oval window

Minor defects do not pose a threat to health, but if the patient has other abnormalities of the heart valves or vascular development, then a venoarterial blood shunt can worsen the movement of blood inside the heart.

Kidney infarction

This condition is especially dangerous in the presence of increased thrombus formation in the veins of the lower extremities. Microthrombi, entering the left atrium, are carried with arterial blood to all organs and, under the influence of pressure, clog the lumen of blood vessels, causing an acute disruption of blood supply - ischemia. This increases the risk of severe complications:

stroke;
cardiac ischemia of varying severity;
kidney infarction.

To learn about the dangers of LLC for children and adults, diagnosis and patient management tactics, watch this video:

When does a patent foramen ovale close normally?

Typically, in a newborn, the window valve is pressed by increased pressure in the left atrium. This occurs after the lungs have fully opened - within 3 to 5 hours. Overgrowth of the hole often lasts from 2 to 11 months. In some children, the oval window closes only by age two. This is considered one of the normal options. If after five years there is an LLC, then self-closure does not occur.

Diagnosis of an open oval window in a child

In order to make a diagnosis, they study the history of the appearance of complaints and their severity, but since they do not have characteristic features, the assumption of LLC can be confirmed using instrumental methods.

Inspection

The child may be stunted, weight loss, pale skin, and when crying or straining the nasolabial triangle and lips turn blue. Usually, auscultation can reveal a murmur due to the transition of blood between the cavities of the heart: from higher to lower pressure.

Ultrasound

When examining, you can identify the hole and the valve that covers it. The volume and direction of blood movement and the presence of other anomalies of the heart and blood vessels are determined. The following signs are typical for an LLC:

Size from 2 to 4.5 mm.
The valve is visible in the left atrium.
The window is located in the middle of the partition.
The walls near the opening are thin (in case of a septal defect, they are thickened).

EchoCG

A two-dimensional echocardiogram shows the diameter of the open window and the movement of the valve, it will help distinguish this pathology from other heart defects. This method helps to detect the presence of turbulent blood flow, its volume and speed. This is the most informative method for diagnosing LLC.

If there are circulatory disorders, then you cannot take part in competitions; the loads must be determined by a cardiologist after performing functional tests.

We can conclude that the presence of an open window does not lead to problems with health if the size is small and there is no excessive physical activity, so treatment is not required. If there is a large defect, it is eliminated using endovascular methods.

ICD-10 code

Q21.1 Atrial septal defect

Epidemiology

Medical statistics indicate that a patent foramen ovale (PFO) in the heart is prevalent in two age categories:

This is normal in children under one year of age. When performing an ultrasound, an anomaly is detected in 40% of newborns.
In adults, this heart defect occurs in 3.6% of the population.
In patients with multiple heart defects, PFO is diagnosed in 8.9% of cases.

In 70% of cases, incomplete fusion of the septum is detected in infancy. In 30% of adults, this disorder manifests itself in the form of a channel or shunt, which provoke various diseases of the cardiovascular system. In healthy and full-term children, the hole closes by 50% in the first year of life.

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Causes of a patent oval window

In most cases, the causes of a patent oval window are associated with genetic predisposition. As a rule, the anomaly is transmitted through the maternal line, but can also occur due to other reasons:

Birth of a premature baby.
Bad habits of the mother during pregnancy (alcohol, drug addiction, smoking).
Congenital defects of the heart muscle.
Toxic drug poisoning during pregnancy.
Central nervous system disorders: severe stress and nervous experiences, emotional exhaustion.
Connective tissue dysplasia.
Unfavorable environment.
Poor nutrition during pregnancy.

Very often, pathology is detected in other pathologies of heart development: open aortic duct, congenital defects of the mitral and tricuspid valves.

Risk factors

Atrial septal defect occurs for various reasons. Risk factors for the pathological condition are most often associated with genetic disorders in the first degree of family ties.

The appearance of the disorder is facilitated by:

Increased physical activity (strength sports, diving, weightlifting, etc.).
Pulmonary embolism in patients with thrombophlebitis of the lower extremities and pelvic organs.
Bad habits of women during pregnancy.
Toxic poisoning.
Premature birth.
Reduced immune status of a woman.
Poor ecological environment.
Deficiency of vitamins and minerals in the female body during pregnancy due to poor nutrition.

In addition to the above factors, the disorder can be triggered by increased pressure in the right side of the heart muscle.

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Pathogenesis

The mechanism for the development of a through hole between the atria is associated with many reasons. The pathogenesis of the anomaly is based on the interaction of internal and external factors. In most cases, these are deviations in the formation, that is, connective tissue dysplasia. The violation leads to the involvement of the heart valves, subvalvular apparatus and cardiac septum in the pathological process.

As the newborn's lungs expand and pulmonary blood flow increases, pressure increases in the left atrium, which helps close the gap. But connective tissue dysplasia interferes with this process. If primary pulmonary hypertension is diagnosed against this background, then the pathology has a favorable prognosis, increasing the patient’s life expectancy.

Hemodynamically insignificant patent foramen ovale

The movement of blood through the vessels is associated with the difference in hydrostatic pressure in different parts of the circulatory system. That is, blood moves from an area of high pressure to low. This phenomenon is called hemodynamics. An open fissure in the wall between the right and left atria is located at the bottom of the oval socket on the inner left wall of the right atrium. The hole has small dimensions from 4.5 mm to 19 mm and, as a rule, has a slit-like shape.

A hemodynamically insignificant patent foramen ovale is an anomaly that does not cause circulatory disturbances and does not affect the patient’s health. This is observed if the defect is small in size and has a valve that prevents the blood from shunting from left to right. In this case, people with pathologies do not suspect its presence and lead a normal lifestyle.

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Symptoms of an open oval window

In most cases, there are no symptoms of a patent oval window. A person learns about the presence of pathology by chance during a routine examination. But the latent course of the disease has a characteristic symptom complex that can remain without proper attention for a long time:

Cyanosis and increased pallor of the nasolabial triangle during physical activity.
Tendency to colds and bronchopulmonary pathologies of an inflammatory nature.
Slow physical development.
Slow weight gain in a child.
Poor appetite.
Respiratory failure.
Sudden fainting.
Signs of cerebrovascular accident.
Frequent headaches and migraines.
Postural hypoxemia syndrome.

The presence of the above symptoms requires careful diagnosis and medical care. If various neurological disorders are observed, this may indicate complications of the disorder due to its prolonged course.

First signs

The congenital communication between the right and left atria has no specific manifestations. The first signs in most cases go unnoticed. A problem is suspected in the following cases:

Severe headaches and dizziness.
Blue lips during coughing and during any other physical activity.
Predisposition to inflammatory lesions of the respiratory system.
Severe respiratory failure during physical exertion.
Fainting state.
Varicose veins and thrombophlebitis of the lower extremities at a young age.

LLC has minimal radiological symptoms to suspect an anomaly: an increase in blood volume in the vascular bed of the lungs and an enlargement of the right heart.

Patent foramen ovale in adults

The main vital organ of any living creature is the heart. In humans, it has a complex structure and is responsible for many functions. The organ includes the left/right ventricles and atria, connected by special valves. A patent foramen ovale in an adult is a pathology that is most often diagnosed in newborns and premature babies.

In adulthood, the unclosed hole is a shunt. Its presence can cause changes in the cardiovascular system and lungs due to differences in blood pressure in the atria. But the presence of this anomaly is not always a cause for concern. Very often people live fully and are not aware of the violation. Only an ultrasound can identify the problem.

The proper functioning of the heart and the body as a whole depends on the size of the defect. The hole size can be from 2 mm to 10 mm.

If the window opens by 2-3 mm, but is not accompanied by deviations from the cardiovascular system, then this condition does not affect the functioning of the body.
If the through hole is 5-7 mm, then this indicates that the disorder is hemodynamically insignificant. The deviation manifests itself only with increased physical activity.
If the dimensions are 7-10 mm, then the patient is diagnosed with a gaping open window. In terms of its symptoms, this type of disease is similar to congenital heart disease.

Inferiority LLC usually does not have specific symptoms. The doctor can only guess about the causes of the painful condition. To identify the disorder, a comprehensive diagnosis is indicated. The presence of clinically insignificant symptoms at first glance is also taken into account:

Blue discoloration of the nasolabial triangle during inflammatory diseases and after physical exertion.
Frequent fainting.
Varicose veins and thrombophlebitis.
Shortness of breath.
Predisposition to colds.
Tachycardia.
Migraine.
Increased blood volume in the lungs.
Frequent numbness of the limbs and impaired body mobility.

This disorder is diagnosed in 30% of people and persists from birth. But the risk of developing the disease increases significantly in athletes and with increased physical activity. The risk group includes: divers and divers, patients with PE (pulmonary embolism) and thrombophlebitis.

Treatment of the painful condition depends on its severity. Many adults are prescribed a range of preventive methods. In particularly severe cases, not only drug therapy is indicated, but also surgical intervention.

Stages

An open gap in the wall between the right and left atrium is a cardiovascular defect. The stages of the pathology are distinguished by the degree of organ damage and the nature of the resulting symptoms. In medical practice, there is such a thing as MARS syndrome (minor anomalies of cardiac development), which includes this disorder. The group of pathologies includes disorders of the development of structures of the external and internal structure of the heart muscle and the vessels adjacent to it.

Incomplete fusion of the septum is included in the general classification of MARS syndrome:

Location and shape.

Atria:
- Open oval window.
- Enlarged Eustachian valve.
- MPP aneurysm.
- Prolapsing valve of the inferior vena cava.
- Trabeculae.
- Prolapsed pectineus muscles in the right atrium.
Tricuspid valve - displacement of the septal leaflet into the cavity of the right ventricle, dilatation of the right AV orifice, protrusion of the tricuspid valve.
Pulmonary artery – prolapse of the pulmonary valve leaflets and dysplasia of its trunk.
Aorta – borderline wide/narrow aortic root, bicuspid valve, sinus dilatation, valve leaflet asymmetry.
Left ventricle – small aneurysm, trabeculae, chords.
Mitral valve.

Causes and conditions of occurrence.

Connective tissue dysplasia.
Autonomic dysfunctions.
Ontogenesis.
Cardiogenesis disorders.

Possible complications.

Heart rhythm disturbances.
Pulmonary hypertension.
Infectious endocarditis.
Cardiohemodynamic disorders.
Fibrosis and calcification of valve leaflets.
Sudden death.

Any form or stage of MARS syndrome is a variant of visceral connective tissue dysplasia. It is characterized by a high frequency of changes in the central nervous system and neurovegetative disorders.

After establishing the type of anomaly, hemodynamic disturbances and regurgitation and their severity are identified. In 95% of cases, hemodynamic disturbances and side symptoms do not occur. As they grow older, structural abnormalities disappear.

Forms

Normally, a patent foramen ovale is temporary, as it is necessary to oxygenate the fetus during embryonic development. That is, the anomaly exists in all children, but by the time of birth it heals, since there is no need for additional oxygen saturation, since the lungs begin to work.

Types of incomplete fusion of the septum depend on the size of the hole:

2-3 mm is the norm, which does not cause deviations or consequences.
5-7 mm – the features of this pathology depend on the presence of concomitant provoking factors.
>7 mm is a gaping hole requiring surgical treatment. According to studies, the maximum size may exceed 19 mm.

In addition to the oval window, there are other cardiac septal defects. Their differences are that the window has a valve responsible for regulating blood flow. LLC is not a heart defect, but refers to minor anomalies in the development of the cardiovascular system.

Patent foramen ovale with reset

In most cases, a through hole between the atria is not a serious concern. Since the pressure in the left atrium is higher than in the right, the valve between the septa is kept closed. This prevents blood from shunting from the right atrium to the left. As a rule, this is observed with window sizes of no more than 5-7 mm.

An open foramen ovale with discharge indicates a large pathology. This is observed with a temporary increase in pressure in the right atrium due to straining, physical exertion, crying or prolonged nervous tension. This condition causes the discharge of venous blood through the LLC, manifested by temporary cyanosis of the nasolabial triangle and blanching of the skin.

The disorder can lead to complications such as paradoxical embolism. Blood clots, gas bubbles, emboli, foreign bodies from the right atrium entering the left atrium and continuing further movement can reach the vessels of the brain. This leads to the development of stroke, thrombosis and heart attacks. To prevent such disorders, comprehensive diagnosis and timely treatment should be carried out.

Patent foramen ovale with left to right shunt

A short channel between the right and left atria, covered by a valve and with abnormal blood circulation, is a patent foramen ovale with a left-to-right shunt. Normally, fluid discharge occurs in one direction - from right to left. LLC is a physiological feature of the body that is necessary during embryonic development. But after birth, the need for it disappears and the gap closes, as the lungs begin to work.

The following types of functioning of the oval window are distinguished:

No hemodynamic reset.
With right-left reset.
With left-right reset.
With biderectoral bypass.

LLC with left-right shunting indicates that the pressure in the right atrium is less than in the left. The main causes of this form of disorder include:

Perforation of the oval window flap.
Valve deficiency due to left atrium enlargement
Valve failure.

Right-left shunting, when the pressure in the right atrium is greater than in the left, occurs due to the following reasons: prematurity and low body weight, increased physical activity and psycho-emotional disorders, neonatal pulmonary hypertension, respiratory distress syndrome.

Patent foramen ovale without signs of embolic activity

A patent foramen ovale is a valve communication between the atria. In the embryonic period, it is responsible for the passage of arterial blood into the left atrium from the right, without affecting the undeveloped vessels of the lungs. In most people, the PFO closes after birth, but in 30% it remains open, causing various pathological symptoms.

With this minor cardiac anomaly there is a high risk of paradoxical embolism. The pathology leads to the fact that small gas bubbles and blood clots enter the left atrium and through the left ventricle with the blood flow into the brain. Blockage of blood vessels in the brain provokes a stroke.

A patent foramen ovale without signs of embolic activity and other pathologies can be regarded as a variant of the normal structure of the heart. But in the presence of provoking factors (physical activity, straining, coughing), the pressure in the right atrium increases and a right-to-left shunt occurs, causing a paradoxical embolism.

Complications and consequences

The lack of timely diagnosis and treatment of the through hole of the atrium is the main reason for the development of various consequences and complications. Patients may experience the following problems:

Heart rhythm disturbances.
Cerebrovascular accident.
Pulmonary hypertension.
Paradoxical embolism.
Fibrosis and calcification of the valve leaflets of the heart muscle.
Cardiohemodynamic disorders.
Heart attack.
Stroke.
Sudden death.

According to medical statistics, the above complications are extremely rare.

Is a patent oval window dangerous?

Many experts consider the congenital communication between the right and left atria to be normal. Whether a patent foramen ovale is dangerous depends entirely on the general health of the patient and the presence of concomitant pathologies.

If the window is small, then as a rule it is not a cause for concern. The patient is prescribed regular examinations by a cardiologist, annual planned ultrasounds of the heart and a set of preventive measures. In the presence of concomitant diseases, LLC can cause serious changes in the cardiovascular system. This is due to the transfer of blood from the right atrium to the left, bypassing the lungs. In this case, any physical activity can cause various complications.

This congenital anomaly is dangerous due to the development of embolism. This is a condition when blood clots, gas bubbles and bacterial microorganisms enter the arterial blood from the venous blood, and through the left side of the heart into the arteries of the internal organs. In this case, the coronary arteries, kidneys, spleen, and limbs may be affected. Heart rhythm disturbances are dangerous due to strokes and heart attacks.

Diagnosis of an open oval window

Minor cardiac anomalies are characterized by a latent, that is, hidden course. Pathology can be suspected in the presence of characteristic symptoms or during a routine examination of the body. Diagnosis of an open oval window is carried out using the following methods:

Taking an anamnesis - the doctor asks about the presence of genetic abnormalities among relatives, about the course of pregnancy, the woman’s bad habits and drug treatment during pregnancy, and the patient’s degree of physical activity.
External examination - this method is ineffective, since LLC does not always make itself felt with clearly expressed symptoms. But blueness of the nasolabial triangle during crying and straining, pallor of the skin, poor appetite and retardation in physical development make it possible to suspect a disorder.
Laboratory tests - to date, there are no genetic tests that would identify MARS syndrome in newborns. Patients are prescribed the following tests:

General and clinical blood test.
Prothrombin gene mutation.
Prothrombin time.
Factor V (Leiden).
Determination of homocysteine and antithrombin levels.
Determination of protein C and protein S levels.

Instrumental studies - for diagnosis, auscultation is performed, that is, listening to the chest for the presence of systolic murmurs. The patient is prescribed cardiac ultrasound, echocardiography, angiography, MRI and a set of other procedures.

During diagnosis, the doctor conducts a nutritional assessment, identifies eating disorders and symptoms of abnormalities associated with an imbalance in the nutrients consumed. The environmental features of the patient’s living environment are also taken into account.

Noise when the foramen ovale is open

One of the methods for diagnosing a through hole between the atria is to listen to the chest using a phonendoscope. When the cardiovascular system operates, peculiar tones arise. The heart pumps blood, and valves regulate its direction.

Before the heart contracts, the valves between the atria and ventricles close.
Blood from the left ventricle enters the aorta, and from the right into the pulmonary artery. When this happens a tone is formed.
The tone occurs when the valves close, if some kind of obstruction forms in the heart, and due to many other factors.

A murmur with an open foramen ovale cannot always be detected using a phonendoscope. This is due to the fact that the pressure difference between the atria is small, so the vortex flow characteristic of the anomaly may not form.

Heart murmur can be: soft, rough, blowing. All noises are divided into the following groups:

Pathological – often the first, and sometimes the only sign of abnormalities of the cardiovascular system.
Healthy - associated with the growth characteristics of the chambers and vessels of the heart, the structural features of the organ.

To determine the nature of the noise and the reasons for its occurrence, the doctor performs echocardiography and ultrasound. These methods allow you to evaluate the structure of the heart and surrounding vessels and tissues.

Instrumental diagnostics

Examination of the body using special equipment is instrumental diagnostics. If an incomplete fusion of the heart septum is suspected, the following studies are indicated:

X-ray – detects possible heart problems caused by increased blood pressure in the right ventricle due to an atrial septal defect.
Heart ultrasound is performed to determine the boundaries of the LLC and its size. Prescribed for newborns and older patients.
Echocardiography is performed if various cardiac anomalies are suspected. Allows you to identify pathology even if it is hidden. It is carried out in two states: after physical activity and during calm.
Transthoracic two-dimensional echocardiography - allows you to identify the inferiority of the oval window valve in newborns. Visualizes the movement of the valve leaflets, determines the speed and volume of blood flow from one atrium to another.
Transnutritive echocardiography is prescribed if an abnormality is suspected in older children and adolescents. During the examination, an endoscope is immersed into the esophagus, bringing it as close as possible to the heart muscle. To obtain more reliable results, bubble contrast may be prescribed.
Cardiac probing is one of the most accurate, but aggressive diagnostic methods. Most often used before surgical interventions. The procedure involves advancing a probe through the arterial bloodstream to the heart for detailed visualization.

Based on the results of instrumental diagnostics, a final diagnosis can be made or additional studies can be prescribed.

Patent foramen ovale on ultrasound

Ultrasound examination of the cardiovascular system is one of the instrumental methods for identifying both congenital and acquired anomalies among newborns and older patients.

An open foramen ovale on ultrasound is characterized by the following symptoms:

Enlargement of the right cardiac chamber.
Small hole sizes - from 2 to 5 mm.
Displacement of the main septum between the atria towards the right atrium.
Thinning of the walls of the interatrial septum.

Using ultrasound, it is possible to visualize the valves in the cavity of the left atrium, assess the general condition of the organ and the volume of blood flow, localization and other features of the pathology.

Sonographic signs of an open oval window

Echocardiography is a diagnostic method using ultrasound waves. It is used to study and determine the localization of internal organs and structures.

Sonographic signs of a patent foramen ovale can be detected immediately after birth using the following studies:

Contrast echocardiography - reveals PFO or atrial septal defect of the smallest size. For diagnosis, the patient is given an intravenous injection with saline solution. If there is a gap, tiny air bubbles will penetrate through it from the right atrium to the left.
Transthoracic two-dimensional echocardiography (EchoCG) - visualizes not only the opening, but also a functioning valve. This method is especially informative in newborns and early childhood patients.

In addition to the above methods, bubble-enhanced transesophageal echocardiography may be prescribed to determine the echographic signs of the disorder.

Dimensions of the open oval window

You can suspect minor cardiac anomalies using their characteristic symptoms, which very often occur in a latent form. The size of the open oval window and the presence of concomitant diseases affect the severity of pathological signs of the disease.

An open gap in the wall between the right and left atria can have the following dimensions:

2-3 mm is considered normal and does not cause any symptoms or complications.
5-7 mm is a small size of the anomaly. When exposed to certain factors, it causes a number of unpleasant symptoms, which can progress without medical diagnosis and treatment.
7 mm or more is a large or gaping window that requires surgical treatment. In rare cases, it can reach maximum sizes of more than 19 mm.

According to studies, in approximately 40% of adults, the opening between the atria is not tightly closed. The average gap size is 4.5 mm. If the window remains completely open, then atrial septal defect is diagnosed, which, unlike PFO, is characterized by the absence of a working valve.

Open oval window 2, 3, 4, 5 mm

Congenital communication between the right and left atria is very often diagnosed in premature newborns and slightly less often in healthy children. An open oval window of 2, 3, 4, 5 mm is considered normal, but under the influence of certain factors it can cause pathological symptoms.

Holes larger than 5 mm occur with characteristic signs that allow one to suspect a violation:

Blueness of the nasolabial triangle during physical activity, crying, screaming.
Slowing of mental and physical development.
Loss of consciousness and dizziness.
Fast fatiguability.
Presence of a heart murmur.
Various disorders of the respiratory system.
Frequent colds.

The appearance of the above symptoms is a reason to immediately consult a cardiologist. After a set of various diagnostic measures, the doctor will prescribe treatment and give recommendations for correcting the disease.

Differential diagnosis

Abnormal valve communication between the atria requires a comprehensive examination and, if necessary, treatment. Differential diagnosis of an open oval window is carried out with pathologies with similar symptoms.

First of all, differentiation is necessary with other interatrial communications:

Atrial septal defect.
Aneurysm of the interatrial septum.
Hemodynamic discharge disorders.

Let's take a closer look at the differences between congenital communication between the right and left atria and atrial septal defect:

Based on the results of the studies, the doctor makes a final diagnosis or prescribes additional examinations/tests.

Treatment of open oval window

Such a minor cardiac anomaly as a through hole between the atria requires special attention. Treatment for an open oval window depends on many factors:

Dimensions and clinical significance of the gap.
Fluctuations in the size of the shunt during physical activity.
Features of the septum (increased extensibility, loss of contractility).
The degree of increase in pressure in the pulmonary artery.
Enlargement of the right side of the heart.
Risk of embolic/cerebral complications.
Presence of concomitant diseases.
General condition of the body.

Treatment tactics are entirely based on the presence or absence of LLC symptoms:

If there are no symptoms, therapy is not required. The patient is recommended to be monitored by a therapist/pediatrician and a cardiologist, and periodically assess the dynamics of the anomaly using ultrasound. If there is a risk of complications (stroke, heart attack, ischemia, lesions of the veins of the lower extremities), then patients are prescribed medications to thin the blood (Warfarin, Aspirin and others).
In the presence of pain symptoms, not only medication, but also surgical treatment is indicated. In case of pronounced right-to-left shunting and the risk of embolism, the defect is closed using an occluding device or a special absorbable patch.

Elkar with an open oval window

One of the methods of treating MARS syndrome is drug therapy. Elkar is prescribed for open foramen ovale from the first days of the disease. Let us consider in more detail the instructions for this drug and the features of its use.

Elkar is a medicine used to correct metabolic processes in the body. The drug contains L-carnitine, an amino acid whose structure is similar to B vitamins. It participates in lipid metabolism, stimulates enzymatic activity and the secretion of gastric juice, and increases resistance to physical stress.

The active component regulates glycogen consumption and increases its reserves in the liver and muscle tissue. It has pronounced lipolytic and anabolic properties.

Indications for use: improvement of the condition of premature babies and newborns after birth injuries, asphyxia. Prescribed for a weak sucking reflex, low muscle tone, poor development of mental and motor functions, and insufficient body weight. The drug is used in the complex therapy of chronic gastritis and pancreatitis, and for dermatological diseases. Accelerates the recovery of the body under intense physical and psycho-emotional stress, with reduced performance and increased fatigue.
Directions for use: the medicine is taken orally 30 minutes before meals. The dosage and course of treatment are individual for each patient and are therefore determined by the attending physician.
Side effects: isolated cases of dyspeptic disorders, myasthenia gravis, gastralgia, systemic allergic reactions have been recorded.
Contraindications: hypersensitivity to the components of the drug. If the medicine is prescribed for patients under 3 years of age, careful medical supervision is required. Not used for the treatment of pregnant women and during lactation.
Overdose: myasthenia gravis, dyspeptic disorders. There is no specific antidote, so symptomatic therapy is indicated.

Elkar is available in the form of an oral solution in bottles of 25, 50 and 100 ml with a dosing device.

Is it necessary to operate on a patent foramen ovale?

Faced with such a diagnosis as a through hole between the atria, many patients wonder: is it necessary to operate on an open foramen ovale? The need for surgical intervention is determined by the size of the gap, the presence of concomitant diseases, painful symptoms and other characteristics of the body.

Medicine states that up to two years of LLC is the norm. The patient must be observed by a cardiologist and undergo annual echocardiography and cardiac ultrasound. If, upon reaching adulthood, the window has not closed, then the patient is strictly registered with a cardiologist, who decides on the method of treating the defect. The doctor takes into account the development of complications: thrombus formation, pulmonary failure, paradoxical embolism, ischemic and cardioembolic stroke.

If the oval window is large, there is no valve (atrial septal defect) or there has been a stroke, then surgery is a direct indication.

Surgery

One of the most effective methods for eliminating PFO is surgical treatment. It is performed at any age, but only if there are the following indications:

Severe hemodynamic disturbances.
High risk of complications.
Severe pain symptoms.
The defect diameter is more than 9 mm.
Rejection of blood into the left atrium.
Limited physical activity caused by pathology.
Contraindications to taking medications.
Complications from the cardiovascular and respiratory systems.

The main goal of surgical intervention is to close the defect with a patch. The procedure is performed through the femoral or radial artery using a special endoscope and injecting contrast.

Surgical treatment is contraindicated for pathological changes in lung tissue and left ventricular failure. As a rule, the operation is performed upon reaching 2-5 years of age, when the window should physiologically close, but this does not happen. Each case is individual and requires a comprehensive comprehensive diagnosis to assess all possible risks of the operation.

Surgery for open oval window

The only and most effective method of treating the residual element of the fetal heart in adult patients is surgery. If the oval window is open, the following surgical interventions may be prescribed:

Open heart surgery.

Through an incision in the chest, the surgeon disconnects the heart from the blood vessels. The functions of the heart are taken over by a special device that pumps blood throughout the body and enriches it with oxygen. Using coronary suction, the doctor clears the organ of blood and makes an incision in the right atrium to eliminate the defect. The method has the following indications:

Hole with a diameter of more than 10 mm.
Severe circulatory disorders.
Exercise intolerance.
Frequent colds and inflammatory diseases.
Pulmonary hypertension.

The following methods are most often used to close the gap:

Suture application - the hole in the interatrial septum is sutured. The same manipulations are carried out for secondary defects located in the upper part of the septum.
Applying a patch made of synthetic fabric, pericardium (a flap of the outer membrane of the heart) or a special patch. This method is used for primary heart defects located closer to the ventricles, in the lower part of the septum.

After the operation, the doctor stitches the incision and connects the heart to its blood vessels. The incision in the chest is closed with a suture.

The advantages of such an operation are high accuracy of execution and rapid restoration of impaired blood circulation in the lungs and throughout the body, as well as the ability to eliminate defects of any size and location. The disadvantages of the method include: the need to connect a machine for artificial blood circulation, trauma due to a large incision in the chest, a long recovery period - about 2 months and rehabilitation up to 6 months.

Endovascular surgery (closing the defect using a catheter).

These are less traumatic operations that do not require opening the chest. Indications:

A window less than 4 mm in the central part of the interatrial septum.
Return of blood from the left atrium to the right.
Increased fatigue.
Shortness of breath during physical activity.

During the operation, the doctor inserts a catheter into holes in large vessels in the groin or neck area. The endoscope is advanced into the right atrium. At the end of the device there is a special device for closing the window:

Button devices - discs are installed on both sides of the interatrial septum, which are connected to each other using a nylon loop.
An occluder is a special device that resembles an umbrella. It is introduced and opened in the left atrium, blocking the flow of blood from it.

The advantages of such minimally invasive treatment are: low risk of complications, the possibility of performing it under local anesthesia, significant improvement in condition immediately after surgery, and a short recovery period of about a month. The main disadvantage of endovascular surgery is that it is not effective for large defects and narrowing of blood vessels. The operation is not performed with a window in the lower part of the septum or at the mouth of the vena cava/pulmonary veins.

Regardless of the surgical procedure chosen, most patients make a full recovery after surgery. There is also an increase in life expectancy by 20-30 years.

Indications for the occluder

If drug therapy is unable to eliminate the pathological symptoms or complications of MARS syndrome, then surgical intervention is indicated. Many patients are prescribed endovascular surgery, that is, the insertion of a special device, most often an occluder, into the heart through a vein or large artery.

Main indications for the occluder:

LLC of small sizes.
Localization of the defect in the central part of the interatrial septum.
Increased fatigue and other symptoms of pathology.

With a minor cardiac anomaly, blood from the left atrium enters the right, and then into the right ventricle and pulmonary artery. This leads to stretching and overload of these parts of the heart. Normally, the left and right parts of the organ are separated from each other by a thin wall, which prevents the reflux of blood. That is, the main indication for the use of an occluder is precisely the enlargement and overload of the right parts of the heart.

An occluder is an umbrella or a miniature mesh. Using a catheter, it is inserted into the femoral vein and placed at the entrance to the left atrium. Implantation is carried out using an X-ray system, which visualizes the entire operation process.

The occluder is made from a biologically inert material that does not cause rejection reactions and takes root well in the body. Six months after the operation, the device is endothelialized, that is, covered with heart cells. In rare cases, after treatment, patients experience complications such as shortness of breath and chest pain.

Prevention

There are no special methods that would prevent incomplete fusion of the cardiac septum. Prevention of an open oval window is based on a healthy lifestyle and compliance with the following recommendations:

Give up bad habits (smoking, alcoholism, drug addiction).
Adhere to a rational and balanced diet that will provide the body with a complex of essential vitamins and minerals.
Timely treatment of any diseases.

Women who are planning to have a child and are already pregnant should pay special attention to the prevention of anomalies:

Avoid infectious diseases. Rubella is especially dangerous, as it provokes LLC and other congenital defects.
Avoid contact with ionizing radiation, for example, X-ray machines, fluorographs.
Do not contact with chemicals and their vapors (paints, varnishes).
Take any medications only as prescribed by a doctor.

Forecast

With timely treatment, compliance with all medical recommendations and observation by a cardiologist, the prognosis for an open foramen ovale is quite favorable. The outcome of the anomaly depends on what therapy was prescribed and how effective it is.

Another important prognostic factor is the functional state of the heart muscle. If there was an operation and it was successful, then there is a high chance of avoiding consequences and complications. This improves the prognosis of the defect. For example, endovascular occlusion of the LLC allows you to return to normal life within a short period of time, without any restrictions.

Without timely diagnosis, drug or surgical treatment, the prognosis of a minor cardiac anomaly is negative. The risk of serious complications exists with large window sizes, the development of paradoxical embolism and the presence of concomitant diseases.

Dispensary observation of children

Abnormal valve communication between the atria requires not only timely treatment, but also medical supervision. Clinical observation of children with a patent oval window involves systematic medical examinations and research (ultrasound, echocardiography). This allows us to assess the dynamics of the disorder and the risk of its complications.

Parents also receive special recommendations. The newborn is shown a protective regimen with long walks in the fresh air and good nutrition. This is necessary to harden the body and increase immune defense. Physiotherapy and therapeutic exercises are also recommended.

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What professions are contraindicated with a patent foramen ovale?

Such a physiological feature as incomplete fusion of the septum of the heart leaves an imprint not only on the lifestyle, but also on the field of activity.

Let's consider which professions are contraindicated when the oval window is open: pilot, diver, diver, scuba diver, driver, machinist, astronaut, caisson worker, army employee or submarine crew member. The above specialties can be dangerous for patients.

For example, when ascending or diving, blood clots can form, blocking blood vessels and causing death. And caisson work is dangerous because the patient has to breathe compressed air, which also negatively affects the cardiovascular system.

Open oval window and sports

Patients with a congenital through hole between the atria have many restrictions that are aimed at minimizing the risk of developing complications of the disease.

An open oval window and sports are acceptable if the defect does not cause abnormal blood flow, blue discoloration of the nasolabial triangle due to physical activity, embolism and other complications. When choosing a sporting hobby, the size of the window, as well as the results of the treatment, are taken into account.

Patent foramen ovale and army

According to the order of the Ministry of Defense of Ukraine dated August 14, 2008 No. 402, an open oval window and the army are incompatible. Patients with this anomaly are partially or completely exempt from military service.

Limited fitness - the disease occurs with bleeding, the conscript is unfit for service in peacetime.

The news of an open foramen ovale in the heart alarms and worries many parents of children of different ages. As a rule, they learn about this diagnosis completely by accident: during a routine examination or an ECG. In some cases, such an anomaly in the development of the heart does not manifest itself at all, and people live for many years without experiencing any inconvenience until serious ones appear.

In recent years, this feature in the structure of the heart has begun to be detected much more often, and in our article we will tell you about an open foramen ovale in the heart and the dangers that this diagnosis may pose in the future.

What is a patent foramen ovale in the heart?

During the first cry of a newborn, the oval window in the heart closes.

The oval window is an open gap in the wall between the right and left atria, which normally functions in the embryonic period and completely closes after 12 months of life. On the left atrium side, the opening is covered by a small valve, which is fully mature by the time of birth.

During the first cry of the newborn and the moment the lungs open, there is a significant increase in pressure in the left atrium and, under its influence, the valve completely closes the oval window. Subsequently, the valve adheres tightly to the wall of the interatrial septum and the gap between the right and left atria closes.

In most cases, in 40-50% of children, such “accretion” of the valve occurs in the first year of life, less often - by the age of five. If the valve size is insufficient, the gap cannot close completely and the right and left atria are not isolated from each other. In such cases, the child may be diagnosed with a patent foramen ovale in the heart (or MARS syndrome). This condition is classified by cardiologists as a minor anomaly of the heart, and, in the absence of severe symptoms affecting the quality of life, can be perceived as an individual feature of the structure of the heart.

An open foramen ovale in the heart is a through hole between the atria through which blood can be pumped from one atrium into another during contraction of the heart muscle.

In adult patients, this anomaly is detected in approximately 30% of cases. It is a channel, or shunt, between the atria and can cause problems in the functioning of the cardiovascular system or lungs due to changes in blood pressure.

Causes

The most common cause of non-closure of the fissure between the atria is a genetic predisposition. In most cases, this anomaly is inherited through the maternal line, but can also be caused by a number of other reasons:

prematurity of the child;
connective tissue dysplasia;
congenital heart defects;
drug addiction or mothers;
smoking during pregnancy;
toxic poisoning from certain medications during pregnancy;
stress;
insufficient nutrition of a pregnant woman;
unfavorable environment.

A patent foramen ovale is often detected with other heart defects: open and congenital defects of the tricuspid and valves.

Various risk factors can contribute to the opening of the oval window:

excessive physical activity (weightlifting and gymnastics, strength sports, diving);
episodes of pulmonary embolism in patients with pelvic or

Symptoms

More often, an open foramen ovale in the heart does not manifest itself in any way, or makes itself felt only by scanty and nonspecific symptoms.

Young children with this anomaly may experience:

blueness or sharp pallor of the circumlabial area or nasolabial triangle during straining, screaming, crying, coughing or bathing;
tendency to bronchopulmonary diseases;
slow weight gain.

Older children may have poor exercise tolerance, which manifests itself by increased heart rate and.

During puberty or during pregnancy, when a total hormonal change occurs in the body, provoking an increase in the load on the cardiovascular system, a patent foramen ovale can manifest itself in frequent episodes and, rapid fatigue and sensations of interruptions in the functioning of the heart. These manifestations are especially pronounced after intense physical activity. In some cases, such an anomaly in the development of the heart can lead to sudden and unmotivated fainting.

Non-closure of the oval window before the age of five indicates that, most likely, this anomaly will accompany the person throughout his life. At a young age and in the absence of cardiovascular lesions, it has practically no effect on his well-being and work activity, but after 40-50 years and the development of heart or vascular diseases, the oval window can aggravate the course of these ailments and complicate their treatment.

Diagnostics

When auscultating heart sounds, the doctor may suspect patent foramen ovale, since this anomaly is accompanied by systolic murmurs of varying intensity. To confirm this diagnosis, the patient is recommended to use more accurate instrumental examination methods:

Echo-CG (conventional and Doppler, transesophageal, contrast);
radiography.

Invasive and more aggressive diagnosis of an open oval window is resorted to if surgery is necessary. In such cases, patients are prescribed probing of the cavities of the heart.

Treatment

If there are no signs of decreased heart function, a child with a patent foramen ovale is cared for as if he were healthy, without the use of medications.

The volume of treatment is determined by the severity of the symptoms of an open oval window. In the absence of pronounced disturbances in the functioning of the heart, the patient is given. Taking medications in the asymptomatic course of such an anomaly of the heart structure is not prescribed, and the patient is recommended to undergo restorative procedures (physical therapy, hardening and sanatorium-resort treatment).

If a patient has minor complaints about the functioning of the cardiovascular system, it may be recommended to take vitamin preparations and products that provide an additional restorative effect on the heart muscle (Panangin, Magne B6, Elcar, Ubiquinone, etc.). In such cases, the patient must adhere to greater restrictions in physical activity and pay attention to general strengthening procedures.

If symptoms are more pronounced, there is a high risk of thrombus formation and there is a significant discharge of blood from one of the atria to the other, the patient is recommended to be monitored by a cardiologist and cardiac surgeon and the following measures may be prescribed:

taking antiplatelet agents and anticoagulants (to prevent blood clots);
endovascular treatment (through a catheter, which is inserted into the femoral artery and advanced into the right atrium, a patch is applied to the oval window, it stimulates the opening to close with connective tissue and resolves on its own after a month).

In the postoperative period, the patient is prescribed antibiotics for prophylaxis. Endovascular treatment of such an anomaly in the development of the heart wall allows patients to return to an absolutely full life without any restrictions.

Possible complications

Complications of patent oval window develop quite rarely. This abnormal structure of the heart wall leads to the following diseases:

kidney infarction;
transient cerebrovascular accident.

The cause of their development is paradoxical embolism. Although this complication is quite rare, the patient should always inform their doctor about the presence of a patent foramen ovale.

Forecasts

In the vast majority of cases, the prognosis for patients with a patent foramen ovale is favorable and rarely results in complications.

constant monitoring by a cardiologist and echo-CG control;
refusal of extreme sports and those involving significant physical activity;
restrictions in the choice of professions associated with significant respiratory and cardiac stress (divers, firefighters, astronauts, pilots, etc.).

Surgical treatment for such an anomaly of heart development is prescribed only in cases of severe disturbances in the functioning of the cardiovascular system and lungs.

Patent foramen ovale (PFO) is a gap in the wall formed between the right and left atria. Normally, such an open gap functions during embryonic development and completely closes during the first year of the child’s life. If this does not happen, we begin to talk about an anomaly, which is assigned code Q21.1 in ICD 10.

On the left atrium side, the opening is covered by a small valve, which is fully matured by the time of birth. When the baby's first cry occurs and the lungs open, there is a significant increase in pressure in the left atrium, under the influence of which the valve completely closes the oval window. Over time, the valve firmly adheres to the wall of the interatrial septum, so the gap between the atria closes.

Most often, in half of children, such valve growth occurs during the first year of life. This is the norm. But if the valve size is insufficient, the gap may not close completely, that is, some hole will remain, the dimensions of which are determined in millimeters. Because of this, the atria are not isolated from each other. Then, which is otherwise called MARS syndrome.

Cardiologists classify it as.

In some cases, when there are no severe symptoms that affect the quality of life, this syndrome may be perceived as an individual feature of the cardiac structure.

But it often happens that such an anomaly becomes known by chance. For an adult, this may come as a surprise. They get scared, thinking that this is a serious vice and their life will soon end. Some young people believe that because of this they will not be allowed into the army. Are there reasons for such concerns? To understand this, you need to understand the causes, symptoms, and other factors associated with LLC.

Causes

So, a patent foramen ovale is an opening, measured in millimeters, that forms between the atria. Through it, blood can flow from one atrium to another. Most often it comes from the left atrium to the right. This is due to the fact that the pressure in the cavity of the left atrium is higher. When a diagnosis is made, the following formulation is often given: LLC with left-right reset.

But LLC is not, although in accordance with ICD 10 they are assigned the same code. A defect is a more serious pathology. MARS syndrome is not a congenital heart defect or a septal defect. And the differences are not only in the structure and development of the heart, but also in the causes, symptoms, treatment and other factors.

The reasons for this condition of the oval window are not always precisely known. It is believed that a hereditary predisposition can lead to this condition. Of course, it’s unlikely that anything can be done about this factor. But there are other reasons that largely depend on the woman who carries a new life within herself; their presence becomes especially important during the period of carrying a child in the womb:

smoking;
malnutrition;
toxic poisoning with drugs;
alcoholism and drug addiction;
stress.

Unfortunately, today more and more women are starting to lead a bad lifestyle and continue to do so even during pregnancy. At the same time, they do not think at all that their baby will suffer. A patent foramen ovale is just one consequence, which can be considered not very serious compared to others, which can be, for example, a heart defect.

A patent oval window may develop due to poor environmental conditions.

LLC can develop for other reasons: poor environmental conditions, connective dysplasia, prematurity of the child. If these reasons occur at a time when, you need to be prepared for the consequences that relate to the development of the baby or the organs of his body.

It has been noted that MARS syndrome often occurs with other cardiac malformations. These include open aortic disease, as well as congenital defects of the mitral and tricuspid valves.

Several other factors can contribute to window opening:

very strong physical activity, which is especially true for athletes who engage in weightlifting, diving, and strength sports;
manifestations of pulmonary embolism in those patients who have thrombophlebitis of the lower extremities and pelvis.

Symptoms

Although the abnormality is often detected in adults during testing for other conditions, it is best to do this early because other heart problems may be detected. Thanks to the identified symptoms, an adult or a child’s parents can seek medical help in time, undergo an examination, after which a diagnosis will be made: LLC with left-right discharge, and a code will be noted in accordance with ICD 10.

If the size of the defect is small, from two to three mm, there is no particular reason to worry, since this is a common situation for a small child. Therefore, there are no special manifestations.

By the way, all children under one year of age are prescribed a heart ultrasound, which makes it possible to identify LLC. If the size of the defect is more than three mm, most likely, some signs will be observed that allow certain conclusions to be drawn:

nasolabial triangle or lips in a child when he cries or screams a lot;
frequent colds, bronchitis, pulmonary inflammation;
slowdown in psychological or physical development, which may even indicate that the oval window is open even by two or three mm;
attacks of loss of consciousness;
fast fatiguability;
feeling of lack of air.

The latter signs are observed when the size of the anomaly exceeds three mm. If the doctor suspects that a child has PFO, he will refer him for examination by an experienced cardiologist and an ultrasound scan. This way the dimensions of the defect are clarified and it turns out that they exceed three mm. All this allows you to understand whether there is cause for concern. By the way, the size of an open window can reach 19 mm.

Cyanosis of the nasolabial triangle may indicate a patent oval window measuring more than three mm

There are practically no specific symptoms in adults. A person may complain of severe pain in the head area. A preliminary diagnosis in accordance with ICD 10 can be made on the basis of almost the same signs that were listed above. There may also be impaired mobility of body parts and periodic numbness of the limbs.

It is important to understand that an open oval window is not a death sentence! The heart is still functioning well, of course, it all depends on what concomitant diseases, heart defects, and so on are present, but in itself PFO does not pose a very serious danger, although the consequences can be very unpleasant, but this will be discussed later. To diagnose PFO with left-right shunting and designate the code according to ICD 10, it is necessary to conduct an examination.

Diagnostics

First, the doctor collects general data about the patient’s health, anamnesis, and complaints. This will help identify the causes and possible complications. A physical examination is also carried out, that is, the doctor examines the skin, determines body weight, measures blood pressure, and listens to heart sounds.

Then a general blood test, urine test, and biochemical blood test are prescribed. These tests help identify comorbidities, cholesterol levels, and other important factors.

In addition, the picture is clarified by such studies as coagulogram, ECG, echo CG, transesophageal, contrast echocardiography, chest x-ray.

All this allows you to accurately assess the patient’s health status, his heart, determine the size of the anomaly in millimeters, and so on.

Thanks to such important studies, the doctor makes an accurate diagnosis and determines the code in accordance with ICD 10. What treatment is prescribed if an open foramen ovale with left-right collection or another similar diagnosis is detected?

Treatment

What to do if you suspect problems with the oval cardiac window? Go to the doctor immediately! This rule applies to everyone who discovers at least some health problems. What to do after visiting a doctor? Follow his recommendations and appointments.

The scope of treatment measures is determined depending on the symptoms and concomitant diseases. Although the ICD 10 abnormality code is atrial septal defect, patent foramen ovale with left-to-right shunt is a different condition.

If there are no obvious disturbances in cardiac function, the doctor gives the patient recommendations that are aimed at properly organizing the daily routine, limiting physical activity, and observing nutritional rules. Taking medications for asymptomatic anomalies is not advisable. General strengthening procedures may be prescribed, such as exercise therapy, treatment in sanatoriums and others.

For minor complaints about the functioning of the heart and blood vessels, vitamins and means to strengthen the heart muscles may be prescribed.

If there are minor complaints about the functioning of the heart and blood vessels, treatment based on taking vitamins and drugs that strengthen the heart muscle can be prescribed. At the same time, it is important for the patient to limit himself in terms of physical activity. If, in a PFO with a left-to-right shunt and a significant size of the anomaly in millimeters, the symptoms are clearly expressed and there is a risk of blood clots, the following may be prescribed:

disaggregants, anticoagulants, these drugs prevent the formation of blood clots;
endovascular treatment, when a patch is applied through a catheter to the oval window, stimulating the opening to close with connective tissue; this patch resolves on its own after a month.

After surgery, antibiotics are prescribed to prevent the possible development of infective endocarditis. Thanks to endovascular treatment, a person returns to a full life, in which there are practically no restrictions.

Under no circumstances should you prescribe medications yourself. Each remedy has contraindications and side effects. For these and other reasons, every prescription should be made by a physician. When a diagnosis is made: a patent foramen ovale in the heart, in accordance with ICD 10, it is important for the patient to know what complications there may be.

Complications and prevention

Of course, the likelihood and form of complications depends on many factors. But it is important to understand that complications are rare. In fact, the following diseases can develop:

renal infarction;
stroke;

If an open foramen ovale is detected, it is necessary to regularly see a cardiologist and perform an ultrasound of the heart.

This occurs because a paradoxical embolism develops. If we talk about forecasts, then in most cases everything is favorable. Those who have been diagnosed with LLC in accordance with ICD 10 need to be regularly monitored by a cardiologist and undergo an ultrasound of the heart. It is necessary to abandon sports that constantly subject the body to very strong physical stress.

It is important for every woman who is planning to have a baby or has already become pregnant to remember that she can prevent her unborn child from developing a heart abnormality. You cannot smoke, drink, take drugs or do anything that could somehow affect the health of the fetus in the womb.

As a result, we can say that LLC is an anomaly, which in itself does not pose a very serious danger, unless we are talking about the fact that there is an accompanying defect or other serious defect. It all depends on various factors. But the health of every person is very often in his hands! Every day you need to think about your health and your loved ones!