The news of an open foramen ovale in the heart alarms and worries many parents of children. 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.
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 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, both the right and left atrium 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 cardiac development, 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 malfunction cardiovascular system or lungs due to changes blood pressure.
Most common cause non-closure of the fissure between the atria becomes genetic predisposition. In most cases, this anomaly is inherited through the maternal line, but can also be caused by a number of other reasons:
A patent foramen ovale is often detected with other heart defects: with open and congenital defects of the tricuspid and valves.
The opening of the oval window can be facilitated by various factors risk:
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:
Older children may have poor exercise tolerance, which manifests itself by increased heart rate and.
During puberty or during pregnancy, when the body experiences total hormonal changes, provoking an increase in the load on the cardiovascular system, an open oval window can manifest itself with 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.
When auscultating heart sounds, the doctor may suspect a 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:
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.
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 for asymptomatic cases of such an anomaly in the structure of the heart 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 agents that provide additional restorative effects 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.
With more severe symptoms, high risk thrombus formation and 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:
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.
Complications of patent oval window develop quite rarely. This abnormal structure of the heart wall leads to the following diseases:
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.
In the vast majority of cases, the prognosis for patients with a patent foramen ovale is favorable and rarely results in complications.
Surgical treatment for such an anomaly of cardiac development is prescribed only when pronounced violations in the functioning of the cardiovascular system and lungs.
The gap in the wall between the right and left atria is the patent foramen ovale. Let's consider the causes and pathogenesis of this phenomenon, methods of treatment and prevention.
According to international classification diseases ICD-10, congenital communication between the right and left atria is included in class XVII: Q00-Q99 Congenital anomalies (malformations), deformations and chromosomal disorders.
Q20-Q28 Congenital anomalies of the circulatory system.
Q21 Congenital anomalies (malformations) of the cardiac septum.
The heart has complex structure and performs many important functions. The organ contracts rhythmically, ensuring blood flow through the vessels. It is located behind the sternum in the middle part of the chest cavity and is surrounded by the lungs. Normally, it can shift to the side, as it hangs on the blood vessels and has an asymmetrical localization. Its base is turned toward the spine, and its apex faces the fifth intercostal space.
Anatomical features of the heart muscle:
Incomplete fusion of the septum is a congenital anomaly, that is, a residual element embryonic development. In essence, it is a hole between the two atria, through which, during contractions, blood is thrown from one ventricle to another.
The interatrial foramen with a valve develops in utero and is a necessary condition normal operation cardiovascular system at this stage of development. It allows some of the placental and oxygenated blood to pass from one atrium to the other without affecting the undeveloped and non-functioning lungs. This ensures normal blood supply to the fetal head and neck, as well as the development of the spinal cord and brain.
At the first cry of a newborn, the lungs open and a significant increase in pressure in the left atrium occurs. Thanks to this, the valve completely closes the embryonic gap. Gradually, the valve tightly fuses with the walls of the interatrial septum. That is, the gap between the right and left atrium closes.
In approximately 50% of cases, valve accretion occurs in the first year of the baby’s life, but in some cases by 3-5 years. If the valve size is small, the gap does not close and the atria are not isolated. This pathology is classified as MARS syndrome, that is, a minor anomaly of heart development. In adult patients, this problem occurs in 30% of cases.
Q21.1 Atrial septal defect
Medical statistics indicate that a patent foramen ovale (PFO) in the heart is prevalent in two age categories:
In 70% of cases, incomplete fusion of the septum is detected even after 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.
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:
Very often, pathology is detected in other pathologies of heart development: open aortic duct, congenital defects of the mitral and tricuspid valves.
Atrial septal defect occurs due to various reasons. Risk factors pathological condition most often associated with genetic disorders in the first degree of family ties.
The appearance of the disorder is facilitated by:
In addition to the above factors, the disorder can be triggered by increased pressure in the right side of the heart muscle.
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. Violation leads to involvement in pathological process heart valves, subvalvular apparatus and cardiac septum.
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.
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 no large sizes from 4.5 mm to 19 mm and usually slit-shaped.
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 has small sizes and a valve that prevents blood from shunting from left to right. In this case, people with pathologies do not suspect its presence and lead a normal lifestyle.
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:
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.
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:
LLC has minimum radiographic symptoms, allowing one to suspect an anomaly: an increase in blood volume in the vascular bed of the lungs and an increase in the right side of the heart.
Basic vital important organ of any living being 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.
LLC inferiority, as a rule, does not have specific symptoms. The doctor can only guess at the reasons 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:
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 complex preventive methods. In especially severe cases, it is indicated not only drug therapy, but also surgical intervention.
An open gap in the wall between the right and left atria 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 external and internal structure heart muscle and adjacent vessels.
Incomplete fusion of the septum is included in general classification MARS syndrome:
Any form or stage of MARS syndrome is a variant of visceral connective tissue dysplasia. It is characterized high frequency 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.
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:
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.
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 reset 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 blood vessels of the brain. This leads to the development of stroke, thrombosis and heart attacks. To prevent such violations, it is necessary to carry out comprehensive diagnostics and timely treatment.
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:
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:
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.
A patent foramen ovale is a valve communication between the atria. During the embryonic period, it is responsible for the passage 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 or other pathologies may be considered an option normal structure hearts. 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.
Absence timely diagnosis and treatment of the through hole of the atrium, is the main cause of the development of various consequences and complications. Patients may experience the following problems:
According to medical statistics, the above complications are extremely rare.
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 complex 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 they may be affected coronary arteries, kidneys, spleen, limbs. Heart rhythm disturbances are dangerous due to strokes and heart attacks.
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:
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.
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.
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:
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.
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:
Based on the results instrumental diagnostics a final diagnosis may be made or additional studies may be ordered.
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:
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.
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:
In addition to the above methods, bubble-enhanced transesophageal echocardiography may be prescribed to determine the echographic signs of the disorder.
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:
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.
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.
Hole sizes larger than 5 mm leak from characteristic features, allowing to suspect a violation:
The appearance of the above symptoms is a reason to immediately contact a cardiologist. After a complex of various diagnostic measures, the doctor will prescribe treatment and give recommendations for correcting the disease.
Abnormal valve communication between the atria requires comprehensive research and treatment if necessary. Differential diagnosis open oval window is performed with pathologies with similar symptoms.
First of all, differentiation is necessary with other interatrial communications:
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.
Such a minor heart anomaly as a through hole between the atria requires special attention. Treatment for an open oval window depends on many factors:
Treatment tactics are entirely based on the presence or absence of LLC symptoms:
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's take a closer look at the instructions this drug and features of its application.
Elkar is medicine, used for correction metabolic processes in the body. The drug contains L-carnitine, an amino acid whose structure is similar to B vitamins. Participates in lipid metabolism, stimulates enzymatic activity and secretion gastric juice, 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.
Elkar is available in the form of an oral solution in bottles of 25, 50 and 100 ml with a dosing device.
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? Necessity surgical intervention 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 fact of 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.
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:
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.
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:
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:
The following methods are most often used to close the gap:
After the operation, the doctor stitches the incision and connects the heart to its blood vessels. The incision on 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 the large incision of the chest, long recovery period– about 2 months and rehabilitation up to 6 months.
These are less traumatic operations that do not require opening the chest. Indications:
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:
The advantages of such minimally invasive treatment are: low risk of complications, the possibility of performing under local anesthesia, significant improvement in condition immediately after surgery, short recovery period - 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.
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:
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 femoral vein and is installed 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.
Special methods There are no 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:
Women who are planning to have a child and are already pregnant should pay special attention to the prevention of anomalies:
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 functional state 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, medication or surgical treatment, the prognosis for minor cardiac anomalies is negative. The risk of serious complications exists with large window sizes, the development of paradoxical embolism and the presence of concomitant diseases.
Abnormal valve communication between the atria requires not only timely treatment, but also medical supervision. Dispensary observation children with a patent oval window provides systematic medical examinations and conducting 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 regime with long walks on fresh air And good nutrition. This is necessary to harden the body and increase immune defense. Physiotherapy and therapeutic exercises are also recommended.
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 lifting or diving, blood clots may form, blocking the vessels and causing death. And caisson work is dangerous because the patient has to breathe compressed air, which also negatively affects the cardiovascular system.
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.
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.
A patent foramen ovale is a serious congenital pathology. But the final decision on the possibility of serving in the army is made by the draft commission.
The severity of symptoms of chronic heart failure can range from minimal symptoms that occur only during physical activity to severe shortness of breath at rest. According to world literature, the number of patients with early manifestations of chronic heart failure is several times greater than seriously ill patients requiring hospital treatment.
– 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, if necessary - surgical treatment(endovascular occlusion of the defect).
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.
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 is completely overgrown with 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 hereditary predisposition, prematurity, congenital heart defects, connective tissue dysplasia, and exposure to adverse factors can lead to an open foramen ovale. external environment, smoking and drinking alcohol by a woman 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 pressing for divers and divers who dive to significant depths and have a 5 times higher risk of developing 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.
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, unlike an atrial septal defect, has a valve structure that ensures the variability of the 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 due to its 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 when the foramen ovale is open 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.
The open oval window has no specific external manifestations, in most cases it proceeds latently, sometimes it can be accompanied by scanty symptoms. Indirect signs of 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 of cerebrovascular accident (especially in patients young, 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 a decrease in arterial blood oxygen saturation in a standing position with improvement when moving to a horizontal position. Complications of a patent oval window occur rarely. For paradoxical embolism cerebral vessels, aggravating this anomaly, is typical sudden development neurological symptoms and the fairly young age of the patient.
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 foramen ovale, instrumental studies and visualization methods are used: 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 increased load on the right parts of the heart, especially on the right atrium. In older people with a patent foramen ovale, radiological signs of enlargement of the right chambers of the heart and an increase in blood volume in the vascular bed of the lungs may be detected.
In newborns and children early age transthoracic two-dimensional echocardiography is used, which allows visually determining the presence of an open oval window and its diameter, obtaining graphic image movements of the valve leaflets over time, to 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 is necessary for patients with varicose veins, thrombophlebitis, cerebrovascular accident, chronic lung diseases, which are at risk of developing paradoxical embolism.
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.
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 of an open oval window, 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.
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"Hole in the heart" is probably a literal translation. In Russian, such a diagnosis sounds like “heart disease.” Defects can be congenital or acquired and are characterized by holes (perforations) in the heart valves, interventricular or presidial septa, large coronary blood vessels and the ascending aortic arch. Many heart defects in the recent past led to disability and death of patients. Currently, high open-heart cardiac surgery technology in combination with developed successful techniques for implanting blood vessels, tissues and stem cells makes it possible to overcome the most severe heart defects.
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Answer:
This could most likely be a prolapse. mitral valve. It may have an unknown cause, or it may be acquired - as an accompaniment of some other disease.
Most often we are talking about hemodynamically insignificant mitral valve prolapse, which is harmless, but it is best to check with your doctor.
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Vetch!
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Parents are somewhat concerned about the health of their newborn, so many diagnoses that doctors make immediately after birth are viewed with caution. Most often, after the first ultrasound performed on the third day of the baby’s life, an open foramen ovale in the heart is diagnosed. Despite the apparent seriousness of the condition, children with such a pathology do not always require special treatment, but only monitoring the condition and regular visits to a specialist. As a rule, the window closes on its own when the child reaches a certain age.
Content:
The oval window is a hole that exists in the interatrial septum through which blood flows from the left atrium to the right. In the fetus in the womb, the lungs do not work, so the pulmonary circulation does not function, and blood through the open oval window (OOF) from the vena cava immediately flows into big circle blood circulation Thus, the gap is observed in any fetus.
After birth and the baby's first breath, the lungs begin their work. As a result of the pressure difference, the gap is closed by a valve. Normally, the oval window should close immediately after birth. But this does not always happen. In most newborns, the valve is too small to completely close the hole. The norm is considered to be closing the window until the end of the baby’s first year of life. There are often cases when it remains open until 3-5 years of age.
A diagnosis doesn't always have to be a cause for concern. It all depends on the size of the gap:
Important: An oval window present at birth is a heart pathology, but not a defect, as some parents think. Often, when the size of the gap is small, no treatment is carried out at all. Many adults who, during examination, are told about an open window in the heart, were not even aware of their condition and led full, active lives.
Most often, the cause of this pathology is hereditary predisposition. In addition, predisposing factors are:
It should be borne in mind that many congenital heart defects also cause a patent window, so when diagnosing this anomaly, doctors insist on a full examination of the baby.
The symptoms that may indicate an opening of the oval window are quite vague, as they can be a sign of a number of other diseases. But if some deviations in the child’s well-being and condition are detected, it is better to show it to a pediatrician to rule out pathologies:
During the examination, which is carried out monthly in children of the first year of life, the pediatrician must listen to the work of the heart. If noises or other audible abnormalities in the functioning of the organ are noted, the child is sent for examination. It should be noted that no pathological changes are detected on the ECG when the foramen ovale is open, therefore the main method for diagnosing PFO in a newborn is cardiac ultrasound, which is performed on the 3rd day after birth, at 1, 3 and 6 months of life.
If the size of the gap in children under 3-5 years of age does not exceed 5 mm, then no special treatment is prescribed; preventive examinations once every 3-6 months and ultrasound monitoring once a year are sufficient. If the window is not closed in children over 5 years of age, they speak of pathology. If the gap size is small and there is no accompanying symptoms, as well as additional cardiac and chronic diseases other organs, the child does not require drug treatment or any surgical interventions.
If the oval window is larger than 5 mm, the child is registered with a cardiologist. If you complain of discomfort or pain, frequent shortness of breath, fatigue, maintenance medications are prescribed.
If the gap is large, which causes disruption of blood circulation, heart function, and, as a result, heart failure, the child is indicated for surgical treatment. Modern technologies make it possible to perform the operation quickly and painlessly, without opening the chest and direct contact with the heart. A catheter is installed in the femoral artery, through which a device (occluder) is delivered to the heart, replacing the valve (it looks like a double-sided umbrella). After installation and deployment, the occluder closes the open foramen ovale, improving the function and functioning of the atria.
An unclosed gap in a newborn is too small, so when it is diagnosed, atrial overload and heart failure are not observed. As the child grows and develops, three options are possible:
In the latter case, free flow of blood from one atrium to another is possible, which significantly increases the load on the organ, so appropriate treatment is carried out, which is prescribed only by a doctor (from maintenance therapy to surgery).
Women with a patent foramen ovale may experience difficulties during pregnancy due to increased load on the body and fetal pressure on all organs, including the heart. People with this pathology experience frequent migraines, dizziness, fatigue, and shortness of breath.
One of the terrible complications is the development of paradoxical embolism, when emboli enter the bloodstream through the LLC, causing a risk of blockage of blood vessels, which leads to death.
For reference: Emboli are any particles (solid, liquid, gaseous) in the bloodstream that are not found there under normal conditions. Emboli can be formed from blood clots (thrombi), fat, gas, microbes, body tissue cells, or foreign body, caught in the lumen of the vessel.
Many parents are afraid that playing sports can affect the quality of life of a child if his foramen ovale has not closed. However, sport is not only not harmful, but is also indicated for such an anomaly, as it strengthens the heart muscle. A child can engage in almost any sport, except for deep-sea swimming and parachute jumping, since there will be sudden changes in pressure, which contributes to an increase in the size of the interatrial septal fissure.
