Open oval window in the heart - Causes, symptoms and treatment. MF.
Nowadays, many parents all often hear from the doctor that their baby has an open oval window in the heart. In this article we will try to find out what it is - a serious diagnosis or an innate feature of the structure of the heart.
Fetal blood circulation
The heart of a newborn baby is very different from the heart of an adult. The heart consists of four chambers( atria and ventricles), and in adults between the atria there is a septum that does not allow mixing arterial and venous blood in the left and right halves of the heart, respectively. In newborn babies, the interatrial septum does not always represent a complete education in connection with the following peculiarities of the fetal circulation: when the baby is still developing in the womb of the woman, the lungs do not take part in independent breathing, so the blood flows to them less( only 12% of the total fetal blood flow).It is necessary that more blood, enriched with oxygen, receive actively functioning organs of the fetus - the brain, liver, etc. To properly distribute blood in the body of the baby, there are vascular communications( messages) in his cardiovascular system. One of these structures, along with the arterial and venous ducts, is the oval window - this is the aperture between the atria, which discharges blood from the right to the left atrium to reduce the flow of blood to the lungs.
From the left ventricle, the window is covered with a small valve, which fully ripens to the delivery. At the time of the first cry of the newborn, when his lungs open, the blood flow to them increases, pressure builds up in the left atrium, and the valve closes the window, and then firmly fuses with the atrial septal wall( in most cases during the first year of the baby's life,five years). Sometimes this valve is too small in size to close the hole, and then it is said that the newborn has an open oval window in the heart.
An open oval window is the opening between the atria in the heart of a person through which blood can flow from one atrium to the other( more often from the left to the right, since the physiological pressure in the cavity of the left atrium is higher).Do not confuse the open oval window with the defect of the interatrial septum, since the defect is a more serious diagnosis related to congenital heart defects, while the open oval window is classified as one of the small anomalies of heart development, and is rather an individual feature of the structurethe child's heart.
Open oval window
Causes of non-rotation of the oval window in the heart
The first place in the structure of the causes of morbidity is a genetic predisposition, especially on the maternal line. Also, the factors that have a negative impact on the fetus during the period of gestation are unfavorable ecological conditions, insufficient nutrition of the pregnant woman, stresses, and the use of toxic substances( alcohol, drugs, nicotine, drugs prohibited for use by pregnant women).
Symptoms of the open oval window
Usually the clinical manifestations of an isolated oval window in children( without the presence of congenital heart diseases) are rather meager. An anomaly of the structure in a newborn child can be suspected on the basis of the following complaints: rapid heart rate, shortness of breath and cyanosis( gray or blue staining) of the nasolabial triangle when crying and feeding. A child may have a poor appetite and poorly gain weight. In older children, there may be a decreased tolerance( tolerance) of physical exertion.
In the period of intensive growth, as well as hormonal changes in the body( adolescence, pregnancy), the load on the cardiovascular system as a whole increases, which can cause fatigue, weakness, and sensations of cardiac disruptions, especially during exercise or sports.
In situations when the oval window does not overgrow and after five years of age, it is more likely that it will accompany a person throughout life, which, however, does not affect his household and work activities. But at an older age( after forty or fifty years), when a person can develop such diseases as arterial hypertension and coronary heart disease, the oval window can complicate the course of the recovery period after myocardial infarction and the course of chronic heart failure.
Diagnosis of the disease
The diagnosis is based on the auscultation( listening) of the chest during the examination of the child( systolic noises are heard), as well as on the basis of instrumental research methods.
The main method for detecting the oval window is visualization with the help of echocardiography( ultrasound of the heart).Ultrasound of the heart should be performed for all children aged 1 month according to the new diagnostic and medical standards in pediatrics.
If the oval window accompanies congenital heart disease, then if necessary, the doctor prescribes a transesophageal echocardiography, an angiographic examination( introduction into the cavity of the heart through vessels of X-ray contrast medium), conducted in a profile cardiosurgical hospital.
Treatment of an open oval window
In the absence of clinical symptoms and hemodynamic disorders( pronounced changes in the work of the heart), which is most often found in the practice of a pediatrician's doctor, neither medical therapy nor hospitalization is shown. Appointed fortifying procedures - tempering, walking in the fresh air, observance of a balanced mode of work and rest, proper nutrition, therapeutic exercise.
With the appearance of minor complaints from the cardiovascular system, it may be justified to prescribe vitamins and drugs that provide additional nutrition to the heart muscle - magnesium B6, panangin, analogues of L-carnitine( elcar), coenzyme Q( ubiquinone).
In cases of a combination with heart defects, the tactics of observation and treatment are determined by the cardiologist and cardiac surgeon with the choice of the optimal method of operative correction of defects. In recent years, London scientists have developed an operation in which a probe with a patch is inserted through the femoral vein into the cavity of the right atrium, which is superimposed on the window, and dissolves within 30 days. This patch creates a semblance of "patch" and additionally stimulates the formation of its own connective tissue in the interatrial septum, which leads to the infection of the oval window. Operative treatment in uncomplicated cases is not applied.
Complications of the oval window in the heart of the
. The "rare", almost single cases of complications include "paradoxical" embolism - a dangerous, life-threatening condition. Emboils are tiny particles carrying gas bubbles, blood clots, or pieces of adipose tissue. These substances are normal in the bloodstream should not be, they enter the bloodstream under various pathological conditions, such as gas bubbles in air embolism, sometimes accompanying complex injuries of the chest with damage to the lung tissue;thrombi - with thrombophlebitis( diseases of veins with the formation of parietal thrombi);Adipose tissue - with open fractures of bones. The danger of these emboli is that when the oval window is open, they can get from the right to the left atrium, then into the left ventricle, then through the vessels to reach the brain, where they clog the lumen of the vessel and cause the development of a stroke or a cerebral infarction. This complication can be fatal. It manifests itself with suddenly developed cerebral symptoms at the moment or immediately after the injury, or during a period of prolonged immobilization, when the patient, after serious operations, injuries, serious illnesses, is forced to long-term bed rest. Prevention of thromboembolic complications in general is adequate therapy aimed at preventing high blood coagulability in acute diseases of the cardiovascular system, in trauma, in surgical interventions, etc.
As mentioned, this complication is quite rare, but nevertheless, a patient with an open oval window should always warn his doctor about the presence of this particular heart structure.
Forecast with open oval window
The prognosis for life, social and labor activity is generally favorable, but patients with an open oval window are contraindicated in extreme sports, as well as occupations associated with increased stress on the circulatory and respiratory system - pilots, astronauts,divers.
Summing up all of the above, it should be noted that in modern medicine, doctors are supposed to refer the open oval window more to the features of the heart structure than to serious malformations, since in most cases the functional load on the heart remains within the normal range. But all the same, because of the localization of this pathology in the heart as a vital organ, it is not worth minimizing its significance. In any case, the doctor's cardiologist determines the tactics of the patient's management individually during the course of internal examination.
Doctor therapist Sazykina O.Yu.